Cost-Effectiveness Analysis of First-Line Tremelimumab Plus Durvalumab Versus Sorafenib in Unresectable Hepatocellular Carcinoma
Author(s)
CHI-HAN CHENG, MS1, Xiao Zang, PhD2, Wendy St. Peter, PharmD, FCCP, FASN, FNKF1;
1College of Pharmacy, University of Minnesota, Department of Pharmaceutical Care & Health Systems, Minneapolis, MN, USA, 2School of Public Health, University of Minnesota, Division of Health Policy and Management, Minneapolis, MN, USA
1College of Pharmacy, University of Minnesota, Department of Pharmaceutical Care & Health Systems, Minneapolis, MN, USA, 2School of Public Health, University of Minnesota, Division of Health Policy and Management, Minneapolis, MN, USA
OBJECTIVES: In the phase 3 HIMALAYA trial (NCT03298451), the STRIDE regimen—tremelimumab plus durvalumab—demonstrated sustained long-term 5-year overall survival (OS) benefits over sorafenib in patients with unresectable hepatocellular carcinoma (uHCC) without prior systemic therapy. Given to the high price of the STRIDE regimen, this study aimed to evaluate the cost-effectiveness of the STRIDE regimen compared to sorafenib as first-line treatment for uHCC in the United States (US).
METHODS: We developed a partitioned survival model with 3 health states: progression-free disease (PFD), progressed disease (PD), and death. Taking a healthcare sector perspective, we estimated costs, quality-adjusted life year (QALYs), incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB) over six-year time horizon. Progression-free survival (PFS) and OS data were derived from the HIMALAYA trial with 772 patients. Model parameters included healthcare utilization costs in 2024 USD from the literature (drug administration, monitoring, subsequent active treatment, best supportive care, and terminal care), utilities for PFD and PD states from the literature, and the price for tremelimumab, durvalumab and sorafenib obtained from the Red Book. One-way and probabilistic sensitivity analyses (PSA) were performed to examine result robustness. Baseline willingness to pay (WTP) threshold was $150,000 per QALY gained, and we also varied the WTP threshold in PSA.
RESULTS: Over 6-year time horizon, the STRIDE regimen yielded an additional 0.32 QALYs (1.54 vs 1.22 QALYs) with incremental costs of $8,437 ($294,049 vs $285,612) compared to sorafenib, resulting in an ICER of $26,477/QALY and an INMB of $39,396. Results were consistent in one-way and probabilistic sensitivity analyses. The STRIDE regimen had 85.6%, 76.8%, and 62.1% probability of being cost-effective at the WTP of $150,000/QALY, $100,000/QALY, and $50,000/QALY, respectively.
CONCLUSIONS: This analysis indicates that tremelimumab plus durvalumab is likely cost-effective compared to sorafenib for the first-line uHCC treatment in the US.
METHODS: We developed a partitioned survival model with 3 health states: progression-free disease (PFD), progressed disease (PD), and death. Taking a healthcare sector perspective, we estimated costs, quality-adjusted life year (QALYs), incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB) over six-year time horizon. Progression-free survival (PFS) and OS data were derived from the HIMALAYA trial with 772 patients. Model parameters included healthcare utilization costs in 2024 USD from the literature (drug administration, monitoring, subsequent active treatment, best supportive care, and terminal care), utilities for PFD and PD states from the literature, and the price for tremelimumab, durvalumab and sorafenib obtained from the Red Book. One-way and probabilistic sensitivity analyses (PSA) were performed to examine result robustness. Baseline willingness to pay (WTP) threshold was $150,000 per QALY gained, and we also varied the WTP threshold in PSA.
RESULTS: Over 6-year time horizon, the STRIDE regimen yielded an additional 0.32 QALYs (1.54 vs 1.22 QALYs) with incremental costs of $8,437 ($294,049 vs $285,612) compared to sorafenib, resulting in an ICER of $26,477/QALY and an INMB of $39,396. Results were consistent in one-way and probabilistic sensitivity analyses. The STRIDE regimen had 85.6%, 76.8%, and 62.1% probability of being cost-effective at the WTP of $150,000/QALY, $100,000/QALY, and $50,000/QALY, respectively.
CONCLUSIONS: This analysis indicates that tremelimumab plus durvalumab is likely cost-effective compared to sorafenib for the first-line uHCC treatment in the US.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE229
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
SDC: Oncology, STA: Biologics & Biosimilars