Abstract
BackgroundHepatic arterial infusion (HAI) of oxaliplatin, leucovorin, and fluorouracil (FOLFOX) plus sorafenib has a more desirable effect versus sorafenib for hepatocellular carcinoma (HCC) patients with portal vein invasion. However, considering the high cost of hepatic arterial infusion of chemotherapy (HAIC), this study evaluated the cost-effectiveness of HAIC plus sorafenib (SoraHAIC) versus standard care for HCC patients from the Chinese health system perspective.MethodsA Markov multi-state model was constructed to simulate the disease course and source consumption of SoraHAIC. Costs of primary therapeutic drugs were calculated based on the national bid price, and hepatic artery catheterization fee was collected from the Fujian Provincial Price Bureau. Clinical data, other costs, and utility values were extracted from references. Primary outcomes included life-years (LYs), quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). The robustness of model was verified by uncertainty sensitivity analyses.ResultsSoraHAIC gained 1.18 QALYs (1.68 LYs) at a cost of $65,254, while the effectiveness and cost of sorafenib were 0.52 QALYs (0.79 LYs) and $14,280, respectively. The ICER of SoraHAIC vs sorafenib was $77,132/QALY ($57,153/LY). Parameter that most influenced the ICER was utility of PFS state. The probabilistic sensitivity analysis (PSA) showed that SoraHAIC was not cost-effective in the WTP threshold of 3*Gross Domestic Product (GDP) per capita of China ($30,492/QALY). But about 38.8% of the simulations were favorable to SoraHAIC at the WTP threshold of 3*GDP per capita of Beijing ($72,000/QALY). When 3*GDP per capita of Fujian ($47,285/QALY) and Gansu Province ($14,595/QALY) were used as WTP threshold, the acceptability of SoraHAIC was 0.3% and 0%, respectively.ConclusionsThe study results indicated that SoraHAIC was not cost-effective in medium-, and low-income regions of China. In developed areas of China (Beijing), there was a 38.8% probability that the SoraHAIC regimen would be cost-effective.
Highlights
Liver cancer, the sixth common human malignancies, ranks the fourth among all the cancer mortality in middle and high sociodemographic index (SDI) countries [1, 2]
Adding hepatic arterial infusion chemotherapy (HAIC) to sorafenib required extra expenditure about $50,974, which resulted in an incremental cost-effectiveness ratio (ICER) of $57,153/LY, and $77,132/quality-adjusted life-years (QALYs) compared with sorafenib (Table 3)
The tornado diagram (Figure 1) displayed the outcomes of oneway sensitivity analysis, which revealed that the model was more sensitive to utility value of progressionfree survival (PFS), and per cycle costs of HAIC and sorafenib
Summary
The sixth common human malignancies, ranks the fourth among all the cancer mortality in middle and high sociodemographic index (SDI) countries [1, 2]. A clinical trial showed that HAI of oxaliplatin, leucovorin, and fluorouracil (FOLFOX) combined with sorafenib in patients with advanced HCC have significantly prolonged OS than oral sorafenib [8]. Based on this published positive clinical survival data, a phase-III trial performed in a Chinese setting, continued to assess the efficacy and safety among those receiving hepatic arterial infusion chemotherapy (HAIC) plus sorafenib (SoraHAIC) compared with those receiving sorafenib alone. Hepatic arterial infusion (HAI) of oxaliplatin, leucovorin, and fluorouracil (FOLFOX) plus sorafenib has a more desirable effect versus sorafenib for hepatocellular carcinoma (HCC) patients with portal vein invasion. Considering the high cost of hepatic arterial infusion of chemotherapy (HAIC), this study evaluated the costeffectiveness of HAIC plus sorafenib (SoraHAIC) versus standard care for HCC patients from the Chinese health system perspective
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