OBJECTIVES: Unresectable Hepatocellular Carcinoma (HCC) poses treatment challenges. The newly FDA-approved Single Tremelimumab Regular Interval Durvalumab (STRIDE) strategy showed promise in clinical trials. This study aimed to assess the cost-effectiveness of STRIDE compared to sorafenib as a first-line treatment for unresectable HCC.

METHODS: A partitioned survival model was constructed to assess the cost-effectiveness of STRIDE versus sorafenib for patients with unresectable HCC from the U.S. healthcare system. The time horizon of the model was 48 months with a one-month cycle. Seven survival functions were used to replicate the survival curves from a phase III randomized controlled trial. The function with the best fitness was used to calculate the survival probability. Direct costs, health utility, and disutility values for adverse events were incorporated. Primary effectiveness measured in quality-adjusted life years (QALYs). A discount rate of 3% were applied to both costs and effectiveness. The incremental cost-effectiveness ratio (ICER) was compared to the $150,000 WTP threshold in the base-case analysis. One-way and probabilistic sensitivity analyses were conducted to identify the robustness of the model.

RESULTS: The ICER of STRIDE compared to sorafenib was $2,079.68 per QALY gained for patients with unresectable HCC in the U.S. healthcare system. The ICER was below the $150,000 WTP threshold, indicating that STRIDE was cost-effective. One-way sensitivity analysis was consistent with the base case. Probabilistic analysis showed a greater than 50% probability of STRIDE being cost-effective at a WTP exceeding $3,100. At a WTP of $150,000, the probability of STRIDE being cost-effective was 99.8%.

CONCLUSIONS: In conclusion, the STRIDE strategy appears to be a cost-effective first-line option for patients unresectable HCC, from the U.S. healthcare system perspective. These findings assist decision-makers, clinicians, and payers in resource allocation and treatment decisions. Continued research and real-world evidence are vital for further refining and validating these findings in the dynamic landscape of oncology.