Cost Effectiveness Analysis of Sorafenib Versus Best Supportive Care in Patients with Advanced Hepatocellular Carcinoma from Health Care System Perspective in Egypt

Abstract

Hepatocellular carcinoma (HCC) is the most common form of liver cancer and is a major health problem accounting for more than 626 000 new cases per year worldwide. It is the third most common cause of cancer death with mortality to incidence ratio of 0.93.The objective of this study was to compare costs and outcomes associated with the use of Sorafenib 200 mg versus best supportive care in patients with advanced HCC over a time horizon of 4 years from the Egyptian health care system perspective. A Markov model was developed to estimate the projected- economic implications of this therapy. Transition probabilities were estimated from the SHARP randomized controlled trial. Health effects were expressed in terms of life-years gained (LYs). Direct medical costs were collected from the local hospitals. All costs and effects were discounted at 3.5% annually, as recommended by Egyptian guidelines. Deterministic sensitivity analysis was performed. Sorasfenib 200mg is revealed to cost an additional cost of EGP 9,906,475 with an expected gain in life years by 0.87 LYG or an incremental cost effectiveness ratio (ICER) of EGP 11,391,257.74 /LYG compared with best supportive care. Deterministic sensitivity analysis showed that Sorafenib median time to radiological progression had the greatest impact on the results. Compared with commonly accepted willingness-to-pay threshold Sorafenib is not cost effective, and yields an ICER value higher than societal willingness- to- pay threshold limits.