Cost-effectiveness analysis of adding transarterial chemoembolisation to lenvatinib as first-line treatment for advanced hepatocellular carcinoma in China

Abstract

Objective The objective of this study was to evaluate the comparative cost-effectiveness of lenvatinib (LEN) plus transarterial chemoembolisation (TACE) (LEN-TACE) and LEN alone to treat advanced hepatocellular carcinoma (HCC) from the perspective of the Chinese healthcare system. Design A three-state partitioned survival model using clinical survival data from a phase III LAUNCH trial, a 5-year time horizon for costs and quality-adjusted life years (QALYs) was constructed to analyse the cost-effectiveness of LEN-TACE. Clinical inputs were extracted from the LAUNCH trial, with outcomes extrapolated using standard and flexible parametric survival models. Costs and utilities derived from published literature were discounted at an annual rate of 5%. Sensitivity analyses and scenario analyses were conducted to test the robustness of the model. Setting The Chinese healthcare system perspective. Participants A hypothetical Chinese cohort of patients with advanced HCC. Interventions TACE plus LEN versus LEN. Primary outcome measure Costs, QALYs, incremental cost-effectiveness ratio (ICER). Results Base-case analysis revealed that LEN-TACE would be cost-effective in China at the willingness-to-pay (WTP) threshold of $37 663 per QALYs, with improved effectiveness of 0.382 QALYs and additional cost of $12 151 (ICER: $31 808 per QALY). The probabilistic sensitivity analysis suggested that LEN-TACE had a 93.5% probability of cost-effectiveness at WTP threshold of three times gross domestic product per capital ($37 663). One-way deterministic sensitivity analysis indicated that the duration of LEN treatment in both two arms, utility of progression-free survival and the cost of TACE had a greater impact on the stability of ICER values. Scenario analyses results were in line with base-case analysis. Conclusions LEN-TACE might be a cost-effective strategy compared with LEN for the first-line treatment of patients with advanced HCC in China.