OBJECTIVES: The price of cancer therapy for the treatment of adult US patients with hepatocellular carcinoma (HCC) remains unknown. This study estimated the price of systemic therapies (ST) compared to selective internal radiotherapy (SIRT) for the treatment of HCC from the payer and provider perspectives.

METHODS: The National Comprehensive Cancer Network (NCCN) Guidelines were used as a framework to model the treatment strategies for HCC. The associated drug prices as of May 2021 for ST and SIRT were obtained from the IBM Micromedex Redbook (Average Wholesale Price [AWP]), (Wholesale Acquisition Cost [WAC]), Medicare’s Average Sale Price (ASP), and Decision Resources Group (DRG) ASP. Clinical parameters, such as treatment duration and FDA-recommended daily dose (DDD), were obtained from randomized controlled trials and FDA-approved labels. The total price/DDD was calculated for each treatment therapy and treatment duration over a short-term (<12 months) horizon. Sensitivity analysis was conducted to explore the impact of treatment duration uncertainty on model results. Because drug rebates are unknown, these price estimates did not account for drug rebates or patient assistance programs negotiated directly with manufacturers by Pharmacy Benefit Managers.

RESULTS: 11 STs and 3 SIRTs were included in our analysis. The median price/DDD of ST varied by perspective: Medicare ASP: $97,466 (IQR: $341-$205,393); Provider WAC: $123,322 (IQR: $18,475-$305,615); Provider AWP: $186,389 (IQR: $22,170-$366,738). The median price for SIRT was estimated; Medicare ASP: $21,877 (IQR: $21,877-$22,269) and Provider ASP: $21,873 (IQR: $21,316–$21,873). The price differences are greater than SIRT when considering patients who progress through first-line and second-line ST.

CONCLUSIONS: The price of cancer therapy for HCC varies widely by payer-provider perspective. The availability of alternative cancer therapies, such as locoregional (non-surgical) approaches, may offer clinical meaningful benefit and reduce the total costs of HCC care from the payer-provider perspectives.