Cost-Effectiveness Analysis of Five Systemic Treatments for Unresectable Hepatocellular Carcinoma in China: An Economic Evaluation Based on Network Meta-Analysis

Mingye Zhao; Xingming Pan; Yue Yin; Hongfei Hu; Jifu Wei; Zhaoshi Bai; Wenxi Tang

doi:10.3389/fpubh.2022.869960

Cost-Effectiveness Analysis of Five Systemic Treatments for Unresectable Hepatocellular Carcinoma in China: An Economic Evaluation Based on Network Meta-Analysis

Front Public Health. 2022 Apr 15:10:869960. doi: 10.3389/fpubh.2022.869960. eCollection 2022.

Authors

Mingye Zhao^{1

2}, Xingming Pan^{1

2}, Yue Yin^{1

2}, Hongfei Hu^{1

2}, Jifu Wei³, Zhaoshi Bai³, Wenxi Tang^{1

2}

Affiliations

¹ Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
² Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
³ Jiangsu Institute of Cancer Research, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.

Abstract

Background and objective: Unresectable hepatocellular carcinoma (uHCC) is the main histological subtype of liver cancer and causes a great disease burden in China. We aimed to evaluate the cost-effectiveness of five first-line systemic treatments newly approved in the Chinese market for the treatment of uHCC, namely, sorafenib, lenvatinib, donafenib, sintilimab plus bevacizumab (D + A), and atezolizumab plus bevacizumab (T + A) from the perspective of China's healthcare system, to provide a basis for decision-making.

Methods: We constructed a network meta-analysis of 4 clinical trials and used fractional polynomial models to indirectly compare the effectiveness of treatments. The partitioned survival model was used for cost-effectiveness analysis. Primary model outcomes included the costs in US dollars and health outcomes in quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of $33,521 (3 times the per capita gross domestic product in China) per QALY. We performed deterministic and probabilistic sensitivity analyses to investigate the robustness. To test the effect of active treatment duration on the conclusions, we performed a scenario analysis.

Results: Compared with sorafenib, lenvatinib, donafenib, D + A, and T + A regimens, it yielded an increase of 0.25, 0.30, 0.95, and 1.46 life-years, respectively. Correspondingly, these four therapies yielded an additional 0.16, 0.19, 0.51, and 0.86 QALYs and all four ICERs, $40,667.92/QALY gained, $27,630.63/QALY gained, $51,877.36/QALY gained, and $130,508.44/QALY gained, were higher than $33,521 except for donafenib. T + A was the most effective treatment and donafenib was the most economical option. Sensitivity and scenario analysis results showed that the base-case analysis was highly reliable.

Conclusion: Although combination therapy could greatly improve patients with uHCC survival benefits, under the current WTP, donafenib is still the most economical option.

Keywords: cost-effectiveness analysis; fractional polynomial; network meta-analysis; partitioned survival; unresectable hepatocellular carcinoma.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Bevacizumab / therapeutic use
Carcinoma, Hepatocellular* / drug therapy
Cost-Benefit Analysis
Humans
Liver Neoplasms* / drug therapy
Network Meta-Analysis
Sorafenib / therapeutic use

Substances

Bevacizumab
Sorafenib