Sorafenib versus Transarterial chemoembolization for advanced-stage hepatocellular carcinoma: a cost-effectiveness analysis

Abstract

BackgroundSorafenib and transarterial chemoembolization (TACE) might both provide survival benefit for advanced hepatocellular carcinoma (HCC). Adopting either as a first-line therapy carries major cost and resource implications. We aimed to estimate the cost-effectiveness of sorafenib and TACE in advanced HCC.MethodsA Markov model was constructed in a hypothetical cohort of patients aged 60 years with advanced HCC and Child-Pugh A/B cirrhosis over a 2-year time frame. Three strategies (full or dose-adjusted sorafenib and TACE) were compared in two cost settings: China and the USA. Transition probabilities, utility and costs were extracted from systematic review of 27 articles. Sensitivity analysis and Monte Carlo analysis were conducted.ResultsFull and dose-adjusted sorafenib respectively produced 0.435 and 0.482 quality-adjusted life years (QALYs) while TACE produced 0.375 QALYs. The incremental cost-effectiveness ratio (ICER) of full-dose sorafenib versus TACE was $101,028.83/QALY in China whereas full-dose sorafenib is a dominant strategy (ICER of -$1,014,507.20/ QALY) compared with TACE in the USA. Compared to full-dose sorafenib, dose-adjusted sorafenib was the dominant strategy with the negative ICERs in both China (−$132,238.94/QALY) and the USA (−$230,058.09/QALY). However, dose-adjusted sorafenib is not available currently, so full-dose sorafenib should be compared with TACE. As the acceptability curves shown, full-dose sorafenib was the optimal strategy at the accepted thresholds of WTP in these two countries. Specifically, full-dose sorafenib was the cost-effective treatment compared with TACE if a WTP was set above $21,670 in the USA, whereas in China, TACE could be more favorable than full-dose sorafenib if a WTP was set below $10,473.ConclusionsDose-adjusted sorafenib may be cost-effective compared to full-dose sorafenib or TACE for advanced HCC patients. However, when confining the comparisons between full-dose sorafenib and TACE, full-dose sorafenib was cost-effective for these patients, under the accepted thresholds of WTP.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4308-7) contains supplementary material, which is available to authorized users.

High HBV Load Weakens Predictive Effect of Serum miR-122 on Response to Sorafenib in Hepatocellular Carcinoma Patients

“…For example, Cabibbo et al report that median OS and median time to radiological progression are separately 10.0 and 4.1 months in the patients with SOR treatment, which help guide doctors to replace second-line therapies in a timely manner [ 21 ]. Chen et al compare SOR with transarterial chemoembolization (TACE) and suggest that dose-adjusted SOR may be cost-effective than TACE for advanced HCC patients, which provide a basis for doctors to improve efficacy and reduce medical costs [ 22 ].…”

Management of intermediate‐stage hepatocellular carcinoma in the elderly with transcatheter arterial chemoembolization failure: Retreatment or switching to systemic therapy?

“…Chen et al showed that TACE and sorafenib treatment have different costs because of different medical charging systems among countries. In US one TACE session costs are more than 5.5 times of the monthly cost of full‐dose sorafenib whereas the costs of TACE procedure in China are lower than the monthly cost of sorafenib 28 . The overall costs incurred by the Italian National Healthcare System for the treatment of intermediate HCC are similar when one TACE session costs are compared with the monthly cost of full‐dose sorafenib 29 …”

“…In US one TACE session costs are more than 5.5 times of the monthly cost of full-dose sorafenib whereas the costs of TACE procedure in China are lower than the monthly cost of sorafenib. 28 The overall costs incurred by the Italian National Healthcare System for the treatment of intermediate HCC are similar when one TACE session costs are compared with the monthly cost of full-dose sorafenib. 29 Based on these considerations, both data on clinical efficacy and cost-effectiveness analysis are required to find the best and conclusive treatment strategy for the treatment of intermediate-stage HCC in the elderly.…”

Treatment of hepatitis C virus infection in patients with hepatocellular carcinoma: Truth or dare?

“…Now, heading to the Markov models, a Canadian model has evaluated the cost‐effectiveness of sofosbuvir/velpatasvir treatment for patients with decompensated cirrhosis, stating that it provided an added four quality‐adjusted life years (QALY), at a cost of $39.169, rendering the approach cost effective at the set threshold of $50.000/QALY 51 . On the other hand, data regarding TACE come as follows: it appears that TACE generates in various settings up to a maximum of three QALYs, never exceeding $50.000/QALY 52–55 . Of note, not all clinical scenarios include TACE for intermediate stage HCC.…”