Cost-Effectiveness Analysis of Hepatic Arterial Infusion of FOLFOX Combined Sorafenib for Advanced Hepatocellular Carcinoma With Portal Vein Invasion

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.

Cost-Effectiveness Analysis of Hepatic Arterial Infusion Chemotherapy of Infusional Fluorouracil, Leucovorin, and Oxaliplatin Versus Transarterial Chemoembolization in Patients With Large Unresectable Hepatocellular Carcinoma

“…As far as we know, there is still very little literature on the cost-effectiveness evaluation of HAIC in the treatment of liver cancer. Only one Chinese-based study by Meiyue Li et al evaluated the cost-effectiveness of the hepatic arterial infusion of FOLFOX plus sorafenib (SoraHAIC) in the treatment of advanced hepatocellular carcinoma with portal vein invasion ( Li et al, 2021 ). The results showed that SoraHAIC was not a cost-effective option compared to sorafenib in low- and medium-income areas of China, while the probability of being cost-effective in high-income areas of China (Beijing) was 38.8%.…”

“…For the FOLFOX-HAIC regimen, the microcatheter was first advanced into the patient’s hepatic artery, and then the drugs were infused through the hepatic artery: oxaliplatin, 130 mg/m 2 ; leucovorin, 400 mg/m 2 ; and fluorouracil, 400 mg/m 2 bolus and 2,400 mg/m 2 over 24 h. Based on the study of Qijiong Li et al ( Li et al, 2022 ), the mean number of HAIC treatments for each patient was 3.6, once every three weeks. The drug prices and hepatic artery catheterization fees were derived from published literature ( Li et al, 2021 ). We also considered the cost of treatment-related grade 3–4 adverse events with a higher incidence of more than 5%, including elevated ALT/AST and vomiting ( Li et al, 2021 ).…”

“…The drug prices and hepatic artery catheterization fees were derived from published literature ( Li et al, 2021 ). We also considered the cost of treatment-related grade 3–4 adverse events with a higher incidence of more than 5%, including elevated ALT/AST and vomiting ( Li et al, 2021 ). The total cost of AEs was the sum of the incidence of each AE multiplied by its associated unit cost.…”

“…The health utility reflected the patient’s quality of life, ranging from 0 (death) to 1 (perfect health). According to published literature in the Chinese setting, the utility value in the state of PFD and RFD after hepatectomy was assumed to be 0.76, and the utility value in the state of PD was 0.68 ( Qin et al, 2018 ; Li et al, 2021 ). In addition, the reduction in utility values caused by grade 3–4 adverse events with a higher incidence of more than 5% was also considered in the model.…”

Use of chemotherapy to treat hepatocellular carcinoma

“…Hence, FOLFOX has been the mainstay of HAIC (97,98). Nevertheless, a cost-effectiveness analysis found that SoraHAIC was moderately cost-effective in developing areas (99). Immune therapy is recommended in the 2021 NCCN guidelines on advanced HCC, so further studies need to be conducted to determine if HAIC is cost-effective.…”