First-Line Systemic Treatment Strategies for unresectable hepatocellular carcinoma : a cost -effectiveness analysis

Abstract: Background Oral multikinase inhibitors and immune checkpoint inhibitors (ICIs) are effective in advanced hepatocellular carcinoma (aHCC) but may increase cost. This study compared the cost-effectiveness of oral multikinase inhibitors and ICIs in first-line patients with aHCC. Methods A three-state Markov model is established to study the cost-effectiveness of drug treatment from the perspective of Chinese payers. The key outcomes were total cost, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) in this study. Results The total costs and QALYs of sorafenib, sunitinib, donafenib, lenvatinib, sorafenib plus erlotinib, linifanib, brivanib, sintilimab plus IBI305, and atezolizumab plus bevacizumab were $9070 and 0.25, $9362 and 0.78, $33814 and 0.45, $49120 and 0.83, $63064 and 0.81, $74814 and 0.82, $81995 and 0.82, $74083 and 0.85, $104188 and 0.84, the drug regimen with the lowest ICER was sunitinib ($551 per QALY), followed by lenvatinib ($68869 per QALY). For oral multikinase inhibitors, ICER of levatinib, sorafenib plus erlotinib, linifanib and brivanib compared with sunitinib was $779576, $1534347, $1768971, $1963064, respectively. For ICIs, sintilimab plus IBI305 is more cost effective than atezolizumab plus bevacizumab. The model was most sensitive to the price of sorafenib, the utility of PD, and the price of second-line drugs. Conclusion For oral multikinase inhibitors, the order of possible treatment options is: sunitinib > lenvatinib > sorafenib plus erlotinib > linifanib > brivanib > donafinb. For ICIs, the order of possible treatment options is: sintilimab plus IBI305 > atezolizumab plus bevacizumab.