Cost-effectiveness of sorafenib as a first-line treatment for advanced hepatocellular carcinoma.
OBJECTIVE
Sorafenib has been shown to significantly improve the overall survival of patients with advanced hepatocellular carcinoma (HCC). This study aimed to assess the cost-effectiveness of sorafenib as a first-line treatment for patients with advanced HCC.


METHODS
To carry out the analysis, we collected the data on the efficacy and safety of patients treated with sorafenib from medical records and follow-up of these patients. A Markov model comprising three health states (progression-free survival, progressive disease, and death) was created to simulate the process of advanced HCC. We calculated the data on cost from the perspective of Chinese patients. Sensitivity analyses were also carried out to explore the impact of several essential variables.


RESULTS
Overall, 94 patients with advanced HCC were included in our study: 70 in the Child-Pugh A group and 24 in the Child-Pugh B group. The median overall survival was 8.0 months (95% confidence interval: 7.21-8.50). In general, treatment with sorafenib was estimated to increase costs by $18,251.84 compared with best supportive care, with a gain of 0.18 quality-adjusted life years (QALYs). Thus, the incremental cost-effective ratio was $101,399.11/QALY for sorafenib versus best supportive care. In addition, in patients with Child-Pugh A liver function, the total costs and effectiveness were $20,643.06 and 0.48 QALYs, respectively, whereas in the Child-Pugh class B group, the total costs and effectiveness were $15,844.33 and 0.28 QALYs.


CONCLUSIONS
On the basis of the commonly accepted willingness-to-pay threshold ($20,301.00/QALY in China), sorafenib is not a cost-effective option as a first-line treatment for patients with advanced HCC.
aState Key Laboratory of Biotherapy, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University bDepartment of Medical Oncology, First People's Hospital of Longquanyi District cDepartment of Medical Oncology, 363 Hospital, Chengdu, Sichuan, China.
Pengfei
P
Zhang
Yu
Y
Yang
Feng
F
Wen
Xiaofeng
X
He
Ruilei
R
Tang
Zedong
Z
Du
Jing
J
Zhou
Jian
J
Zhang
Qiu
Q
Li
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D002681:China; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D000077157:Sorafenib; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib