OBJECTIVES: Tremelimumab + durvalumab (STRIDE) and atezolizumab + bevacizumab are the NCCN and ESMO recommended first-line (1L) IO treatment options for uHCC. This study aimed to quantify the total economic burden associated with treating uHCC patients with STRIDE compared to atezolizumab + bevacizumab from the Canadian payer perspective.

METHODS: A total cost-of-care model was developed, in which drug- (including treatment acquisition and treatment administration) and non-drug-related costs (including healthcare resources use, endoscopy costs, and costs of treating Grade ≥3 treatment-emergent adverse events [TEAEs]), were compared across uHCC patients eligible to receive 1L IO therapy (i.e., Barcelona Clinic Liver Cancer [BCLC] C patients with Child-Pugh A or BCLC B patients with Child-Pugh A who were ineligible for locoregional treatment). Healthcare resource rates were sourced from the literature and the costs were calculated based on progression-free survival, accounting for physician visits, lab and radiological tests, and hospitalization. Grade 3/4 TEAEs and mean duration of treatment were derived from the HIMALAYA and IMbrave150 trials. Unit costs were collected from both public and commercial sources, valued in 2023 Canadian dollars.

RESULTS: From a Canadian payer perspective, there was an average cost savings of $16,869 per patient per year when patients were treated with STRIDE compared to atezolizumab + bevacizumab. The main drivers of cost savings were lower costs associated with endoscopy (-100%), drug administration (-71%), and TEAE management (-54%). The incremental cost offset to the health plan was $4,174,158 per year when treated with STRIDE.

CONCLUSIONS: This is the first study that holistically captures the cost of treating uHCC patients over one year. This study suggests that STRIDE offers cost savings for uHCC treatment in the Canadian healthcare system. However, additional real-world evidence studies are warranted to capture the long-term survival benefits and associated treatment costs.