Cost-effectiveness analysis of systemic therapies for advanced hepatocellular carcinoma.

Abstract

606 Background: The management of unresectable and metastatic HCC has evolved over the years with the introduction of immunotherapy. Currently, three FDA-approved first-line treatment combinations are available: ipilimumab plus nivolumab (ipi+nivo), atezolizumab plus bevacizumab (atezo+bev), and durvalumab plus tremelimumab (durva+trem). We evaluated the cost-effectiveness of ipi+nivo combination therapy compared to atezo+bev, durva+trem, and sorafenib. Methods: We assessed the long-term costs and quality-adjusted life years (QALYs) for ipi+nivo using a partitioned survival analysis by simulating patient outcomes over a 10-year time horizon based on published survival curves from the CheckMate 9DW trial. Cost inputs for ipi+nivo were obtained from previously published data on its use in melanoma. We calculated the incremental cost-effectiveness ratios (ICERs) for each of the treatment combinations by comparing ipi+nivo simulation results to published cost effectiveness estimates of atezo+bev, durva+trem, and sorafenib. Results: Over 10 years, ipi+nivo had an average cost of $308,616 and 2.25 QALYs (Table 1). Ipi+nivo had a $22,623 per additional QALY (0.7 QALYs gained) compared to atezo+bev, $85,889 per additional QALY (1.23 QALYs gained) compared to sorafenib, and $239,444 per additional QALY (0.5 QALYs gained) compared to durva+trem. Conclusions: Preliminary results suggest that ipi + nivo combination therapy is a cost-effective treatment option for hepatocellular carcinoma, although durva+trem appears dominant. Further sensitivity analyses and longer-term survival data of each regimen collected under comparable settings are needed to confirm these findings. Comparison of life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) relative to sorafenib. Strategy Total LYs Total QALYs Total cost ($) ICER ($/QALY) Ipi+Nivo 3.28 2.25 308,616 85,889 Atezo+Bev 3.03 1.55 292,780 169,447 Durva+Trem 2.47 1.75 188,894 -19,286 Sorafenib 1.74 1.02 202,973 -