OBJECTIVES: Sorafenib improves survival in AHCC (Llovet, NEJM 2008), and has been considered cost-effective in Canada (Muszbek, Curr Med Res Opin 2008), when compared with BSC. In clinical practice, however, patients with AHCC with no access to sorafenib are often treated with other systemic agents, none of which are able to improve the outcome. The objective of this study was to evaluate the cost-effectiveness of sorafenib+BSC vs BSC alone in Brazil, from the perspective of the private health-care system. METHODS: A Markov model was developed to project the lifetime survival and costs for both interventions using data from the TTP and OS Kaplan-Meier curves from SHARP trial in a lognormal distribution and from an ad hoc panel with Brazilian medical oncologists, hepatologists, and liver surgeons. Treatment effectiveness was measured in life-years gained (LYG). Resource utilization included drug, administration, physician visits, monitoring, and adverse events. Costs (in R$, with R$ 1.00 ~ US$ 0.58) and survival benefits were discounted annually at 5%. Univariate and probabilistic sensitivity analyses were conducted. RESULTS: Lifetime per-patient costs in R$ (US$) were 103,210 (58,977) and 10,435 (5,963) for sorafenib+BSC and BSC alone, respectively. Sorafenib drug cost accounted for nearly 80% of treatment costs. The incremental survival benefit with sorafenib+BSC was 0.49 life-years. The incremental cost-effectiveness ratio of sorafenib+BSC vs BSC alone was R$ 189,402 (US$ 108,230) per LYG. CONCLUSIONS: The addition of sorafenib to BSC is the only intervention that has been found to improve survival in AHCC and the cost-effectiveness results reflects the increased cost of an active treatment when compared with a low cost and ineffective alternative.