title: Cost-effectiveness of sorafenib treatment in field practice for patients with hepatocellular carcinoma.
abstract: The purpose was to assess the cost-effectiveness of sorafenib in the treatment of hepatocellular carcinoma (HCC) patients incorporating current prices and the results of the recent published field practice SOraFenib Italian Assessment (SOFIA) study. We created a Markov Decision Model to evaluate, in a hypothetical cohort of Caucasian male patients, aged 67 years with Barcelona Clinic Liver Cancer (BCLC) C HCC, or BCLC B HCC who were unfit or failed to respond to locoregional therapies, well compensated cirrhosis, and with performance status 0-1 according to Eastern Cooperative Oncology Group (ECOG), the cost-effectiveness of the following strategies: (1) full or dose-adjusted sorafenib for BCLC B and C patients together; (2) full or dose-adjusted sorafenib for BCLC B patients; (3) full or dose-adjusted sorafenib for BCLC C patients. Outcomes include quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER). In the base-case analysis dose-adjusted sorafenib was the most effective of the evaluated strategies. For dose-adjusted sorafenib, QALY was 0.44 for BCLC B and C patients together, 0.44 for BCLC C patients, and 0.38 for BCLC B patients. The ICER of dose-adjusted sorafenib compared with BSC was €34,534 per QALY gained for BCLC B and C patients together, €27,916 per QALY gained for BCLC C patients, and €54,881 per QALY gained for BCLC B patients. Results were sensitive to BSC survival rate, and sorafenib treatment duration.
  
  
  CONCLUSIONS
  In daily practice dose-adjusted, but not full-dose, sorafenib is a cost-effective treatment compared to BSC in intermediate and advanced HCC.
authors.affiliation: Sezione di Gastroenterologia, DIBIMIS, University of Palermo, Italy. calogero.camma@unipa.it
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cabibbo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.forename: Marco
authors.initials: M
authors.lastname: Enea
authors.forename: Massimo
authors.initials: M
authors.lastname: Iavarone
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Erica
authors.initials: E
authors.lastname: Villa
authors.forename: Claudio
authors.initials: C
authors.lastname: Zavaglia
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bruno
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D008297:Male; D008390:Markov Chains; D015999:Multivariate Analysis; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000191:economics* / Q000627:therapeutic use*; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib