Abstract
Lenvatinib is an oral multikinase inhibitor indicated for the first-line treatment of unresectable hepatocellular carcinoma (uHCC). In the Phase III REFLECT trial, lenvatinib was noninferior in the primary endpoint of overall survival versus sorafenib, the only systemic therapy funded in Canada prior to the introduction of lenvatinib. Lenvatinib also demonstrated statistically significant improvement compared to sorafenib in secondary endpoint progression-free survival, time to progression, and objective response rate. The aim of this analysis was to estimate the cost-effectiveness of lenvatinib versus sorafenib for the first-line treatment of patients with uHCC from a Canadian perspective. A cost-utility analysis was conducted using partitioned survival modelling, with health states representing progression-free disease, progressed disease, and death. Health effects were measured using quality-adjusted life years (QALYs), and costs were represented in Canadian dollars. Clinical inputs were derived from the REFLECT trial, with outcomes extrapolated using parametric survival models. EQ-5D data collected in REFLECT were used to determine health state utility values, and estimates of resource use came from a survey of clinicians. The model predicted incremental costs of-$5,021 and incremental QALYs of 0.17, making lenvatinib dominant over sorafenib. The model demonstrates lenvatinib to be a cost-effective use of resources versus sorafenib in Canada for the treatment of uHCC. Overall costs are lower compared with sorafenib, while health benefits are greater, with modelled progression-free and overall survival extended by 4.1 and 2.6 months in the lenvatinib arm, respectively.
Highlights
Hepatocellular carcinoma (HCC) accounts for approximately 90% of liver cancers globally [1] and approximately 72% in Canada [2]
Assuming a conservative price reduction of 15% for sorafenib and the utilization of postprogression treatment of regorafenib, lenvatinib remained dominant compared to sorafenib
E results of 5,000 simulations were plotted on the costeffectiveness plane (Figure 2). e average incremental savings over the simulated results were $4,921, and the average incremental qualityadjusted life years (QALYs) gained were 0.17; this is highly congruent with deterministic changes in costs and QALYs of –$5,021and 0.17, respectively. 100% of simulations were considered cost-effective at a threshold of $50,000 per QALY
Summary
Hepatocellular carcinoma (HCC) accounts for approximately 90% of liver cancers globally [1] and approximately 72% in Canada [2]. It is estimated that 3,000 Canadians were diagnosed with liver cancer in 2019, with around 1,400 deaths [3], reflecting the poor survival rate, approximately 20% over five years [2]. Prognosis is dependent on liver function, performance status, and tumor type [4]. Canadian Journal of Gastroenterology and Hepatology Progression-free Progressed Dead Input. Drug therapy costs (per cycle) Lenvatinib Sorafenib. Medical resource use costs (per cycle) Physician visits (progression-free) Physician visits (progressed) Laboratory tests (progression-free) Laboratory tests (progressed) Radiological tests (progression-free) Radiological tests (progressed) Hospitalisation (progression-free) Hospitalisation (progressed).
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