Cost-effectiveness analysis of FOLFOX4 and sorafenib for the treatment of advanced hepatocellular carcinoma in China

Abstract

ObjectivesHepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. In China, sorafenib and oxaliplatin plus infusional-fluorouracil/leucovorin (FOLFOX4) are approved for the systemic treatment of advanced HCC. This study compared the cost-effectiveness of these therapies from a healthcare system perspective and a patient perspectives.MethodsA Markov model was constructed using overall and progression-free survival rates and adverse event (AE) rate from two randomized controlled studies of advanced HCC patients from Asia: EACH for FOLFOX4 and ORIENTAL for sorafenib. The patients in the Markov model were followed until death, the length of each Markov cycle was 1 month, and the survival was adjusted for quality-adjusted life years (QALYs). Direct medical costs included costs of therapies, AE treatment, general ward and tests. Costs were derived from published sources, interviews with oncologists and hospital data from China. One-way and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the results.ResultsFrom the healthcare system perspective, FOLFOX4 dominated sorafenib with lower therapy costs (FOLFOX4: US$ 6972; sorafenib: US$ 12,289), lower direct medical costs (FOLFOX4: US$ 8428; sorafenib: US$ 12,798), and higher QALYs (FOLFOX4: 0.42; sorafenib: 0.38) per patient. This result was robust according to comprehensive one-way sensitivity analyses. According to the PSA, at the cost-effectiveness threshold for China (3 × GDP, US$ 22,073), FOLFOX4 should be chosen in 63.9% of simulations. From the patient perspective, FOLFOX4 also dominated sorafenib.ConclusionsThe study results indicate that FOLFOX4 dominates sorafenib because it appears to provide higher effectiveness with significantly lower costs in treating Chinese advanced HCC patients.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0112-0) contains supplementary material, which is available to authorized users.

Comparative clinical effects and cost–effectiveness of maximum androgen blockade, docetaxel with androgen deprivation therapy and ADT alone for the treatment of mHSPC in China

“…Body surface area (BSA; cm 2 ) was calculated as 0.0061 × height (cm) + 0.0128 × weight (kg) -0.1529. An average height of 161.5 cm and an average weight of 61.8 kg, as reported in the literature [26], were used to represent a typical Chinese adult with terminal cancer.…”

Efficacy of anti-PD-1 antibody SHR-1210 as second-line treatment in hepatocellular carcinoma patient with sorafenib resistance

“…[1,13] The prognosis is extremely poor, and the treatments for advanced HCC are very limited. [1,2] Although regorafenib has been approved as a second-line treatment for patients with advanced HCC who show progression after sorafenib therapy, the treatment efficacy remains insufficient, and the side effects are intolerable for many patients. [1,6] With the development of immune therapy, the treatment effects on HCC need to be urgently explored.…”

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