NICE has developed a medtech innovation briefing (MIB) on SIR‑Spheres for treating inoperable hepatocellular carcinoma.
SIR‑Spheres are a form of selective internal radiation therapy consisting of resin microspheres containing radioactive yttrium‑90. They are designed to be used to treat patients with inoperable hepatocellular carcinoma. SIR‑Spheres can also be used to downstage tumours for resection or liver transplantation, or as a bridge to transplantation. SIR‑Spheres deliver radiation directly to tumours through the hepatic artery, which limits damage to normal liver cells. The evidence from 11 studies summarised in this briefing is of mixed quality. Where overall survival was a primary outcome, studies generally showed mixed results. For example, 2 comparative studies (1 prospective, 1 retrospective) showed no significant difference in disease control with SIR‑Spheres compared with drug-eluting bead transarterial chemoembolisation (DEB-TACE) using doxorubicin or with sorafenib. The evidence also generally showed no significant difference in adverse events between SIR‑Spheres and transarterial chemoembolisation (TACE), and between SIR‑Spheres and sorafenib. One study reported fewer any-grade adverse effects with SIR-Spheres compared with sorafenib but the incidence of severe adverse effects was similar. The list price of SIR‑Spheres is £8,000, excluding VAT. The total price used to reimburse NHS centres is about £21,550, which covers the total cost of the SIR Spheres treatment.
NICE has produced a Medtech innovation briefing on another selective internal radiation therapy technology, TheraSphere.
MIBs provide a description of the medical technology, including its likely place in therapy, the costs of using the technology and a critical review of the strengths and weaknesses of the relevant published evidence.
Their purpose is to provide objective information on device and diagnostic technologies to aid local decision-making by clinicians, managers and procurement professionals. By making this information available, NICE helps to avoid the need for NHS organisations to produce similar information for local use.
MIBs are not NICE guidance. They differ in format, contain no judgement on the value of the technology and do not constitute a guidance recommendation.
MIBs are commissioned by NHS England and produced in support of the NHS 5 Year Forward View, specifically as one of a number of steps which will accelerate innovation in new treatments and diagnostics.