EFFECTIVENESS AND COST-EFFECTIVENESS ANALYSIS OF IMMUNOTHERAPY OR TARGETED THERAPY FOR CHINESE PATIENTS WITH ADVANCED HEPATOCELLULAR CARCINOMA: A NETWORK META-ANALYSIS AND SEQUENTIAL MODEL
Author(s)
Hanrui Zheng, Master1, Liangwen Gou, Master2, MING HU, PhD3.
1West China School of Pharmacy, Sichuan University, Chengdu, China, 2Sichuan public health general clinical center, Chengdu, China, 3Professor, Sichuan University, Chengdu, China.
1West China School of Pharmacy, Sichuan University, Chengdu, China, 2Sichuan public health general clinical center, Chengdu, China, 3Professor, Sichuan University, Chengdu, China.
OBJECTIVES: Significant challenges persist in the management of advanced hepatocellular carcinoma (HCC). Evidence-based recommendations for subsequent second-line therapy after disease progression remain insufficiently defined. This study aimed to evaluate the comparative therapeutic efficacy and pharmacoeconomic profiles of various sequential treatment strategies to inform clinical decision-making in advanced HCC management from the perspective of the Chinese healthcare system.
METHODS: A Markov model was constructed to simulate sequential treatment pathways for advanced HCC, with model inputs derived from randomized controlled trial data covering six first‑line regimens (atezolizumab+bevacizumab, sintilimab+bevacizumab biosimilar, sorafenib, lenvatinib, donafenib, and camrelizumab+apatinib) and four second‑line options (regorafenib, pembrolizumab, cabozantinib, and apatinib). Relative treatment effects were estimated via network meta‑analysis to derive transition probabilities. Effectiveness was measured using quality-adjusted life years (QALYs), and cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was set at three times China’s per capita GDP in 2024. Deterministic one-way sensitivity analyses and probabilistic sensitivity analyses were constructed to evaluate the robustness of study conclusions across plausible ranges of input parameters.
RESULTS: The highest QALYs (1.565) were yielded by the sequential regimen of sintilimab+bevacizumab followed by regorafenib. The lenvatinib-regorafenib sequence was found to be the most cost‑effective strategy, followed by the sorafenib-regorafenib and sintilimab+bevacizumab biosimilar-regorafenib sequences. Sensitivity analyses further indicated that drug hazard ratios, drug costs, and the utility discount rate were the main determinants of cost‑effectiveness.
CONCLUSIONS: The sequential regimen of sintilimab plus bevacizumab followed by regorafenib was identified as the most effective treatment strategy, whereas the lenvatinib-regorafenib sequence represented the most cost‑effective option. Nevertheless, further real‑world evidence is warranted to validate the comparative effectiveness, safety, and economic outcomes associated with these second‑line sequential regimens.
METHODS: A Markov model was constructed to simulate sequential treatment pathways for advanced HCC, with model inputs derived from randomized controlled trial data covering six first‑line regimens (atezolizumab+bevacizumab, sintilimab+bevacizumab biosimilar, sorafenib, lenvatinib, donafenib, and camrelizumab+apatinib) and four second‑line options (regorafenib, pembrolizumab, cabozantinib, and apatinib). Relative treatment effects were estimated via network meta‑analysis to derive transition probabilities. Effectiveness was measured using quality-adjusted life years (QALYs), and cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was set at three times China’s per capita GDP in 2024. Deterministic one-way sensitivity analyses and probabilistic sensitivity analyses were constructed to evaluate the robustness of study conclusions across plausible ranges of input parameters.
RESULTS: The highest QALYs (1.565) were yielded by the sequential regimen of sintilimab+bevacizumab followed by regorafenib. The lenvatinib-regorafenib sequence was found to be the most cost‑effective strategy, followed by the sorafenib-regorafenib and sintilimab+bevacizumab biosimilar-regorafenib sequences. Sensitivity analyses further indicated that drug hazard ratios, drug costs, and the utility discount rate were the main determinants of cost‑effectiveness.
CONCLUSIONS: The sequential regimen of sintilimab plus bevacizumab followed by regorafenib was identified as the most effective treatment strategy, whereas the lenvatinib-regorafenib sequence represented the most cost‑effective option. Nevertheless, further real‑world evidence is warranted to validate the comparative effectiveness, safety, and economic outcomes associated with these second‑line sequential regimens.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE696
Topic
Clinical Outcomes, Economic Evaluation
Disease
Oncology