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e16159 Background: Evidence synthesis can be used to demonstrate the economic value of medical technologies. Transarterial radioembolization (TARE) is a clinically effective therapy for hepatocellular carcinoma (HCC); however, a synthesis of the comparative economic outcomes is lacking. This study systematically reviewed and summarized the available economic evaluations of TARE for the treatment of HCC. Methods: A systematic review of economic evaluations of TARE for HCC treatment following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. English and Spanish publications were identified from PubMed, Embase, Cochrane, MEDES, health technology assessment agencies, and scientific congress databases published through May 2021. Results: Among 423 records screened, 20 economic evaluations (two cost-effectiveness analyses (CEAs), eight cost-utility analyses (CUAs), one cost-minimization analysis, six cost analyses, and three budget impact analyses) met the pre-defined criteria for inclusion. Included studies were evaluated from a payer perspective (n = 20) and included both payer and societal perspectives (n = 2). Thirteen studies were published from a European perspective, six from the United States, and one from the Canadian perspective. Included studies evaluated early (n = 4) vs. intermediate and advanced HCC (n = 15). TheraSphere and Sir-Spheres were the most evaluated TARE therapies compared to transarterial chemoembolization (TACE) (n = 12) alone or TACE/sorafenib agents (n = 10). The time horizon in the included studies varied: TARE vs. sorafenib (5-years and lifetime) and TARE vs. TACE (5-years). Variability in health outcomes was observed with greater health benefits reported for TARE vs. TACE for intermediate (n = 1) and advanced-stage patients (n = 2) and TARE vs. sorafenib for intermediate (n = 1) and advanced-stage patients (n = 6). All CEAs compared the costs and survival benefits of TARE vs. TACE/Transarterial embolization (TAE)/sorafenib/tyrosine-kinase inhibitor. Of the 20 studies, TARE was associated with lower treatment costs in ten studies. From the payer perspective, TARE costs varied widely in the Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from $1,770 (BCLC-A) to $66,800 (BCLC-C). The life-years gained (LYG) ranged from 1.1 years (TARE vs. sorafenib/lenvatinib) to 3.1 years (TARE vs. TACE/TAE/drug-eluting bead-TACE). The incremental cost-utility ratio (ICUR) for TARE vs. sorafenib ranged from $38,352/QALY to $71,386 (dominant) and one CUA of TARE vs. TACE and showed an ICUR of $22,181/QALY. Conclusions: Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term treatment for HCC, driven by increased LYG compared to other HCC therapies.

BACKGROUND Inadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting. OBJECTIVE The objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC). METHODS A multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group. RESULTS The technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019. CONCLUSIONS Progress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients’ preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/10938