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| Cost-effectiveness analysis of transcatheter arterial chemoembolization with or without sorafenib for the treatment of unresectable hepatocellular carcinoma |
| Rong-Ce Zhao, Jing Zhou, Yong-Gang Wei, Fei Liu, Ke-Fei Chen, Qiu Li and Bo Li |
Chengdu, China
Author Affiliations: Department of Liver Surgery and Liver Transplantation Center (Zhao RC, Wei YG, Liu F, Chen KF and Li B) and Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy (Zhou J and Li Q), West China Hospital, Sichuan University, Chengdu 610041, China
Corresponding Author: Prof. Bo Li, MD, Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu 610041, China (Tel: +86-28-85422469; Fax: +86-28-85422469; Email: cdlibo168@hotmail.com) |
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Abstract BACKGROUND: Transcatheter arterial chemoembolization (TACE) and TACE in combination with sorafenib (TACE-sorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma (HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.
METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.
RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.
CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.
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2017, Vol. 16 
