title: Cost-effectiveness of sorafenib versus SBRT for unresectable advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  Stereotactic body radiotherapy (SBRT) has been shown to improve overall survival in patients with advanced hepatocellular carcinoma. This study aimed to assess the cost-effectiveness of SBRT compared to sorafenib which is the only drug for advanced hepatocellular carcinoma.
  
  
  METHODS
  A Markov decision-analytic model was performed to compare the cost-effectiveness of SBRT and sorafenib for unresectable advanced hepatocellular carcinoma. Patients transitioned between three health states: stable disease, progression disease and death. We calculated the data on cost from the perspective of our National Health Insurance Bureau. Sensitivity analyses were conducted to determine the impact of several variables.
  
  
  RESULTS
  The incremental cost effectiveness ratio (ICER) for sorafenib compared to SBRT was NT$3,788,238 per quality-adjusted life year gained (cost/QALY), which was higher than the willingness to pay threshold of Taiwan according to WHO's guideline. One-way sensitivity analysis revealed that the utility of progression disease for the sorafenib treatment, utility of progression free survival for SBRT, utility of progression free survival for sorafenib, utility of PFS to progression disease for SBRT and transition probability of progression disease to dead for SBRT were the most sensitive parameters in all cost scenarios. The Monte-Carlo simulation demonstrated that the probability of cost-effectiveness at a willingness to pay threshold of NT$ 2,213,145 per QALY was 100 % and 0 % chance for SBRT and sorafenib.
  
  
  CONCLUSIONS
  This study indicated that SBRT for advanced hepatocellular carcinoma is cost-effective at a willingness to pay threshold as defined by WHO guideline in Taiwan.
authors.affiliation: Department of Radiation Therapy, An Nan Hospital, China medical University, No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, Taiwan.|Department of Nursing, Min-Hwei College of Health Care management, No.111 6, Sec 2, Zongshan E. Rd., Liuying Township, Tainan City, 736, Taiwan.
authors.forename: Henry W C
authors.initials: HW
authors.lastname: Leung
authors.affiliation: Department of Information Management, Chia Nan University of Pharmacy & Science, No. 60, Sec 1, Erren Rd., Rende Dist., Tainan City, 71710, Taiwan.
authors.forename: Chung-Feng
authors.initials: CF
authors.lastname: Liu
authors.affiliation: Department of Pharmacy, An-Nan Hospital, China Medical University, 1. No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, Taiwan. agnes.lf@gmail.com.
authors.forename: Agnes L F
authors.initials: AL
authors.lastname: Chan
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000532:radiotherapy*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000191:economics / Q000627:therapeutic use*; D011336:Probability; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D000077157:Sorafenib; D013624:Taiwan
chemical_list: D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: Advanced hepatocellular carcinoma; Cost-effectiveness analysis; ICER; Sorafenib