title: FOLFOX4 or sorafenib as the first-line treatments for advanced hepatocellular carcinoma: A cost-effectiveness analysis.
abstract: BACKGROUND
  This study aimed to investigate the pharmaco-economic implications of FOLFOX4 or sorafenib for advanced hepatocellular carcinoma in China.
  
  
  METHODS
  To conduct the analysis, we performed a Markov model to simulate the process of advanced HCC treated with sorafenib or FOLFOX4. Clinical data were obtained from the ORIENTAL trial and the EACH trial. Incremental cost-effectiveness ratio was regarded as the primary outcome in the analysis. One-way sensitivity analysis as well as probabilistic sensitivity analysis was performed to explore the impact of essential variables on the results of the analysis.
  
  
  RESULTS
  Treatment with sorafenib provided an effectiveness gain of 0.3935 quality-adjusted life year at an average cost of $18,748.00, whereas chemotherapy of FOLFOX4 brought 0.3808 quality-adjusted life year at a cost of $6876.02. The incremental cost-effectiveness ratio of FOLFOX4 versus sorafenib was $934,801.57/QALY. In a probabilistic sensitivity analysis based on a Monte Carlo simulation of 1000 items, the probabilities of FOLFOX4 and sorafenib being cost-effective were 100% and 0% using a willingness-to-pay threshold of $20,301.00 per quality-adjusted life year.
  
  
  CONCLUSIONS
  FOLFOX4 chemotherapy is likely to be a cost-effective option compared with sorafenib in the treatment of advanced hepatocellular carcinoma in China.
authors.affiliation: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China; West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China; West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wen
authors.affiliation: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China; West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China. Electronic address: keythera@126.com.
authors.forename: Qiu
authors.initials: Q
authors.lastname: Li
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D002681:China; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000191:economics / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D009944:Organoplatinum Compounds / Q000191:economics / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000077157:Sorafenib
chemical_list: D009944:Organoplatinum Compounds; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D002955:Leucovorin; D005472:Fluorouracil
keywords: Chemotherapy; Hepatocellular carcinoma; Pharmaco-economic; Sorafenib