Cost-effectiveness of atezolizumab plus bevacizumab versus sorafenib as first-line therapy in unresectable hepatocellular carcinoma in the US and Chinese setting: a modelling comparison study

Abstract

Objective: Atezolizumab plus bevacizumab demonstrates a significant improvement in overall survival and progression-free survival compared with sorafenib in patients with unresectable hepatocellular carcinoma (HCC). The combined usage of these two medications could result in substantial consumption of resources, primarily due to their exceptionally high costs. The current study aims to evaluate the cost-effectiveness of atezolizumab plus bevacizumab as a first-line treatment for advanced HCC from the perspective of payers in developed and developing countries.

Design: A partitioned survival model was constructed to evaluate the cost-effectiveness of atezolizumab plus bevacizumab versus sorafenib as a first-line treatment for advanced HCC. The efficacy and safety data incorporated within the model were derived from the IMbrave150 trial. Costs and utilities were extracted from published sources.

Interventions: Atezolizumab plus bevacizumab versus sorafenib.

Outcome measures: Estimates were calculated for costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER) for both treatment strategies. One-way sensitivity, probabilistic sensitivity, expected value of perfect information (EVPI), subgroup and scenario analyses were conducted.

Results: The combination therapy of atezolizumab and bevacizumab results in an additional 0.72 life-years/0.57 QALYs in the USA and 0.64 life-years/0.47 QALYs in China compared with standard sorafenib treatment, although with a significant increase in costs, yielding an average ICER of US$253 247.07/QALY in the USA and US$181 552.71/QALY in China. The probability sensitivity analysis indicated that atezolizumab plus bevacizumab demonstrated a 13.60% likelihood of cost-effectiveness in the USA, whereas this likelihood is negligible (0%) in China. The expected value of uncertainty, as quantified by the EVPI, was estimated at approximately US$3658.41/patient in the USA and US$0/patient in China. The ICER was most sensitive to the cost of subsequent treatment in the USA, and most sensitive to the cost of atezolizumab in China. In scenario analyses, the atezolizumab plus bevacizumab treatment becomes favourable when the cost of atezolizumab decreases to 67.85% and 18.45% of its original price in the USA and China, respectively.

Conclusions: The atezolizumab plus bevacizumab is unlikely to be cost-effective compared with sorafenib for patients with unresectable HCC in the context of the USA and China. The implementation of significant reductions in drug prices may render the treatment economically viable.

Keywords: Decision Making; Health economics; Health policy; Hepatobiliary tumours.

Figure 1. Model structure of the partitioned survival model with the three health states. (A) Treatment strategies. (B) Partitioned survival model. P, partitioned survival model.

Figure 2. Tornado diagram of one-way sensitivity analyses of atezolizumab plus bevacizumab versus sorafenib in (A) USA (B) China. A, atezolizumab; B, bevacizumab; ICER, incremental cost-effectiveness ratio; PD, progressed disease; PFS, progression-free survival; QALY, quality-adjusted life-years; S, sorafenib; TKI, tyrosine kinase inhibitor.

Figure 3. Probabilistic sensitivity analyses of atezolizumab plus bevacizumab versus sorafenib (A) Cost-effectiveness plane (B) Acceptability curves. QALY, quality-adjusted life-years.

Figure 4. Value of information analysis results among different scenarios in (A) USA (B) China. QALY, quality-adjusted life-years.

Figure 5. Subgroup analysis results in the USA and China. A, atezolizumab; B, bevacizumab; ECOG, Eastern Cooperative Oncology Group; IC, tumor-infiltrating immune cell; INHB, incremental net health benefit; PD-L1, programmed cell death-ligand 1; S, sorafenib; TC, tumor cell.