Clinical outcomes of pressure-enabled drug delivery for trans-arterial chemoembolization and radioembolization

Aim: Prior research observed that pressure-enabled drug delivery (PEDD) counteracts intra-tumoral pressure during trans-arterial chemoembolization (TACE) and radioembolization (TARE), improving drug penetration, yet real-world evidence remains limited. This study examined outcomes associated with PEDD use, including in high-adopter facilities, and assessed potential cost avoidance associated with PEDD. Materials & methods: We used the Clarivate Real World Data repository to identify adults with hepatocellular carcinoma or secondary liver metastases who received TACE or TARE procedures (January 2020-March 2024). We compared baseline characteristics between PEDD and non-PEDD cohorts, then used a two-stage matching approach to develop a matched sample for comparative analyses. Facilities in the top fifth percentile of PEDD volume were examined separately. Results: In total, 603 PEDD and 16,210 non-PEDD patients were identified. PEDD patients had higher baseline disease burden on average. In matched analyses, PEDD was associated with reduced rates of fatigue overall (20.9% vs 26.4%, p < 0.05) and 30-day inpatient visits among patients receiving TACE procedures (8.0% vs 20.5%, p < 0.05). In high-adopter facilities, PEDD use was associated with reduced lymphopenia among all patients (0.6% vs 5.2%, p < 0.05) and reduced fatigue (19.2% vs 39.7%, p < 0.05) and lymphopenia (0.0% vs 8.2%, p < 0.05) among patients with secondary liver metastases. PEDD use was linked to a per-patient charge avoidance of $7734 through fewer complications ($4599) and inpatient stays ($3135). Conclusion: Despite greater patient comorbidity, PEDD use was associated with fewer post-procedure complications and lower healthcare resource utilization. Greater institutional experience may enhance patient outcomes. Reduced complications and hospitalizations can translate into cost avoidance, reinforcing the value of PEDD technology in clinical practice.