Cost-effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib for Patients With Unresectable or Metastatic Hepatocellular Carcinoma

Abstract

IMPORTANCE Atezolizumab plus bevacizumab as a first-line therapy for patients with unresectable or metastatic hepatocellular carcinoma has been shown to improve overall and progression-free survival compared with standard sorafenib treatment. However, because of the high cost of atezolizumab plus bevacizumab, assessment of its value by considering both efficacy and cost is needed.OBJECTIVE To evaluate the cost-effectiveness of atezolizumab plus bevacizumab vs sorafenib for patients with unresectable or metastatic hepatocellular carcinoma from a US payer perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was performed from Junethrough September 2020, with a 6-year investment time period. Hypothetical patients were male and female adults 18 years or older who had a diagnosis of locally advanced metastatic or unresectable hepatocellular carcinoma confirmed by histologic or clinical features. MAIN OUTCOMES AND MEASURESHealth care costs (adjusted to 2020 US dollars), life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of atezolizumab plus bevacizumab vs sorafenib were examined using a partitioned survival model. One-way deterministic and probabilistic sensitivity analyses were used to examine model uncertainty. The model was also used to estimate price reductions of atezolizumab plus bevacizumab that would achieve more favorable cost-effectiveness. RESULTSIn the base case analysis of a hypothetical sample of 424 patients, atezolizumab plus bevacizumab was associated with an increase of 0.623 life-years (1.840 vs 1.218 life-years) and 0.484 QALYs (1.412 vs 0.928 QALYs

Sintilimab Plus Bevacizumab Biosimilar Versus Sorafenib as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

“…Some studies have evaluated the cost-effectiveness of immunotherapy in HCC. Almost all studies have shown that immunotherapy is unlikely to be a cost-effective option compared to sorafenib, although the ICERs reported by these studies vary ( Hou and Wu 2020 ; Chiang et al, 2021a ; Su et al, 2021 ; Wen et al, 2021 ; Zhang et al, 2021 ). Four of these studies that used clinical data from the IMbrave150 trial evaluated the economics of atezolizumab plus bevacizumab in the first-line treatment of HCC from the perspective of the United States ( Chiang et al, 2021a ; Su et al, 2021 ; Wen et al, 2021 ; Zhang et al, 2021 ).…”

Cost-Effectiveness of Short-Course Radiation Plus Temozolomide for the Treatment of Newly Diagnosed Glioblastoma Among Elderly Patients in China and the United States

“…Instead, the partitioned survival model can use the survival functions fitted to the original survival data directly and is more likely to deliver real health outcomes and associated costs. Therefore, it has distinct advantages over the Markov model ( Connock et al, 2019 ) and is being increasingly used to track disease progression in the field of oncology in recent years ( Wan et al, 2017 ; Connock et al, 2019 ; Su et al, 2021 ; Zhang et al, 2021 ).…”

“…This corresponded to ¥70,581 ($10,054) and ¥2,11,743 ($30,162) in 2019, respectively ( National Bureau of Statis, 2019 ). The WTP threshold in the US was between $1,00,000 and $1,50,000 per QALY gained ( Messali et al, 2013 ; Su et al, 2021 ; Zhang et al, 2021 ). All these parameters were entered into a model in which the utilities were assigned the beta distribution and costs were assigned the gamma distribution.…”

Hepatocellular carcinoma with complete response to the immunotherapy: the oncologist’s dilemma

“…In terms of cost-effectiveness the combination of atezolizumab and bevacizumab was shown to be of clinical benefit but was not cost-effective compared to sorafenib. The incremental increase in the quality-of-life years per patient was US$ 156,210 and an increment cost effective ratio of 322,500 per quality-adjusted life year (10).…”