OBJECTIVES: Hepatocellular carcinoma has one of the highest cancer-induced mortality rates worldwide, ranking fourth among cancer-related deceases. The incidence of HCC is currently increasing in North and Latin America and Central Europe. The incidence is much higher in men than in women. This systematic review was aimed to evaluate the cost-effectiveness of atezolizumab + bevacizumab (ATZ/BVC) compared to sorafenib (SFB) in advanced hepatocellular carcinoma (AHCC).

METHODS: A comprehensive search in databases was performed to find related economic studies. The target population was AHCC patients. Intervention and comparator were ATZ/BVC and SFB, respectively. We included studies that reported quality-adjusted-life-years (QALYs) and/or life-years gained (LYGs), costs, and incremental cost-effectiveness ratio (ICER), and finally, the characteristics of included studies were categorized.

RESULTS: Out of 208 identified records, five cost-effectiveness analyses were eligible for inclusion in the systematic review. These studies showed that for ATZ/BVC compared to SFB, incremental costs were from US$77,140 to $242,447 per patient. Incremental QALYs were from 0.44 to 0.84, and ICERs were from 145,546 to 322,500 $/QALY in different contexts. In most cases, the willingness to pay threshold in all studies was much lower than their ICER, which indicated a reluctance to pay for this treatment strategy by the health systems.

CONCLUSIONS: It can be concluded that ATZ/BVC combination is an expensive approach in AHCC management. Significant reductions in ATZ and BVC prices are essential for this novel approach to be extensively used worldwide.