OBJECTIVES:

Durvalumab monotherapy (DM) is non-inferior to Sorafenib for patients with advanced hepatocellular carcinoma (HCC). This study aimed to evaluate the cost-effectiveness of Tremelimumab and its combination with Durvalumab to treat HCC from the US payer perspective.

METHODS:

A Markov model with 3 discrete health states (no progression, progression, and death) was used to assess the cost-effectiveness of 3 regimens vs 1500 mg DM for HCC. The three regimens included 750mg Tremelimumab monotherapy (TM), 75mg Tremelimumab plus 1500mg Durvalumab (T75D), and 300mg Tremelimumab plus 1500mg Durvalumab (T300D). Patients’ baseline characteristics, progression-free survival time, and overall survival time were extracted from a published randomized clinical trial report (NCT02519348). Drug prices were extracted from the 2022 average sales price files of Centers for Medicare & Medicaid Services. Other medical costs were extracted from previous studies and were inflated to 2022 values. Health utility values of each health state and disutility values of each adverse event were extracted from the literature. A 3% discount rate was applied to the costs and utilities. The half-cycle correction was applied to adjust for the midway transition.

RESULTS:

TM, T75D, and T300D resulted in incremental costs of $963,810, $9,247, and $102,335 and 0.08, -0.15, and 0.30 quality-adjusted life years (QALYs) gained, respectively, compared to DM. The incremental cost-utility ratios for TM, T75D, and T300D compared to DM were $12,850,800, -$63,407, and $338,296 per QALY gained respectively. The corresponding incremental net health benefits were -6.35, -0.21, and -0.38 QALYs, and the corresponding incremental net monetary benefits were -$952,560, -$31,122, and -$56,960 at a willingness-to-pay threshold of $150,000/QALY. The probabilistic sensitivity analysis indicated that DM was the most cost-effective option. One-way sensitivity analysis suggested that the results were most sensitive to the cost of Tremelimumab.

CONCLUSIONS:

TM, T75D, and T300D were unlikely to be cost-effective options compared to DM.