Cost-effectiveness analysis of antiviral therapy in patients with advanced hepatitis B virus-related hepatocellular carcinoma treated with sorafenib.
OBJECTIVE
Antiviral therapy has been demonstrated to significantly improve the survival in patients with advanced hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). The aim of the study was to investigate the cost-effectiveness of antiviral therapy in patients with advanced HBV-related HCC treated with sorafenib.


METHODS
To conduct the analysis, a Markov model comprising three health states (progression-free survival, progressive disease, and death) was created. The efficacy data were derived from medical records. Cost data were collected based on the Chinese national drug prices. Utility data came from the previously published studies. One-way sensitivity analyses as well as probabilistic sensitivity analyses were performed to explore model uncertainties.


RESULTS
In the base-case analysis, addition of antiviral therapy to sorafenib generated an effectiveness of 0.68 quality-adjusted life years (QALYs) at a cost of $25 026.04, while sorafenib monotherapy gained an effectiveness of 0.42 QALYs at a cost of $20 249.64. The incremental cost-effectiveness ratio (ICER) was $18 370.77/QALY for antiviral therapy group versus non-antiviral therapy group. On the other hand, the ICER between the two groups in patients with high or low HBV-DNA load, with or without cirrhosis, normal or elevated alanine aminotransferase/aspartate aminotransferase were $16 613.97/QALY, $19 774.16/QALY, $14 587.66/QALY, $19 873.84/QALY, $17 947.07/QALY, and $18 785.58/QALY, respectively.


CONCLUSIONS
Based on the cost-effectiveness threshold ($20 301.00/QALY in China), addition of antiviral therapy to sorafenib is considered to be a cost-effective option compared with sorafenib monotherapy in patients with advanced HBV-related HCC in China from the patient's perspective.
Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, Sichuan, China.
Pengfei
P
Zhang
Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, Sichuan, China.
Yu
Y
Yang
Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, Sichuan, China.
Feng
F
Wen
School of Public Health, University of Michigan, Ann Arbor, Michigan, 48109, USA.
John
J
Wheeler
West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, Sichuan, China.|Division of Nephrology, Department of Internal Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Ping
P
Fu
Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, Sichuan, China.
Qiu
Q
Li
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000821:virology; D002681:China; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000821:virology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000191:economics* / Q000627:therapeutic use*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D000077157:Sorafenib; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
antiviral therapy; cost-effectiveness; hepatitis B virus; hepatocellular carcinoma; sorafenib