Cost-effectiveness of Camrelizumab Plus Rivoceranib for Advanced Hepatocellular Carcinoma in the Context of Regional Disparities in China

Overview

Journal Front Oncol

Specialty Oncology

Date 2024 Dec 23

PMID 39711961

Authors

Zhonghua Zhao

Xiongying Jiang

Shiping Wen

Yanzhang Hao

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the cost-effectiveness of combining camrelizumab with rivoceranib versus sorafenib as initial treatment options for advanced hepatocellular carcinoma (HCC) across different developmental regions in China.

Methods: Utilizing TreeAge Pro and data from the phase III randomized CARES-310 clinical trial, a model based on Markov state transitions was developed. Health state utility values were derived from the CARES-310 trial, and direct medical costs were obtained from relevant literature and local pricing data. The primary outcome measured was the incremental cost-effectiveness ratio (ICER), defined as the cost per additional quality-adjusted life year (QALY) gained per person. The ICERs were compared against the willingness-to-pay (WTP) thresholds of different regions in China, including low-income ($16,426.80), medium-income ($34,319.01), and high-income regions ($81,036.63). Sensitivity analyses were also conducted to assess the robustness and reliability of the model under various assumptions. A tornado diagram was used to illustrate the impact of parameter variations on the model's cost-effectiveness.

Results: For base case analysis, QALYs per person for the cohort receiving sorafenib were 0.91, with a corresponding cost of $8,860.97. For the cohort receiving camrelizumab plus rivoceranib, the QALYs per person were 1.71, with a corresponding cost of $16,190.72. The camrelizumab plus rivoceranib treatment group exhibited an increase of 0.80 QALYs and an additional expenditure of $7,329.75. The calculated ICER was $9,150.75 per QALY, which is below the WTP thresholds for all regions in China. The camrelizumab plus rivoceranib regimen is regarded as highly cost-effective in medium-income areas of China, with a probability of 99.9%. In high-income regions, the probability reaches 100.0%. Even in low-income regions, this regimen is considered 95.6% cost-effective. Sensitivity analysis further verified that these findings were robust across various assumptions.

Conclusion: The combination of camrelizumab and rivoceranib as a treatment strategy not only improves health outcomes but also represents a cost-effective option across different developmental regions in China.

References

Balcar L, Scheiner B, Fulgenzi C, DAlessio A, Pomej K, Bofill Roig M . A meta-analysis and real-world cohort study on the sex-related differences in efficacy and safety of immunotherapy for hepatocellular carcinoma. JHEP Rep. 2024; 6(2):100982. PMC: 10809085. DOI: 10.1016/j.jhepr.2023.100982. View

Wu X, Yang L, Chen Y, Chen Z, Lu H, Shen X . Transcatheter arterial chemoembolisation combined with lenvatinib plus camrelizumab as conversion therapy for unresectable hepatocellular carcinoma: a single-arm, multicentre, prospective study. EClinicalMedicine. 2024; 67:102367. PMC: 10758712. DOI: 10.1016/j.eclinm.2023.102367. View

Llovet J, Pinyol R, Yarchoan M, Singal A, Marron T, Schwartz M . Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma. Nat Rev Clin Oncol. 2024; 21(4):294-311. DOI: 10.1038/s41571-024-00868-0. View

Wang Z, Lin T, Xing X, Cai B, Chen Y . Dynamic distribution, regional differences and convergence of health workforce allocation in township health centers in China. Heliyon. 2024; 10(1):e23857. PMC: 10772724. DOI: 10.1016/j.heliyon.2023.e23857. View

Peng Y, Zeng X, Peng L, Liu Q, Yi L, Luo X . Sintilimab Plus Bevacizumab Biosimilar Versus Sorafenib as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. Front Pharmacol. 2022; 13:778505. PMC: 8864224. DOI: 10.3389/fphar.2022.778505. View

Koh L, Glaetzer C, Li S, Zhang M . Health Technology Assessment, International Reference Pricing, and Budget Control Tools from China's Perspective: What Are the Current Developments and Future Considerations?. Value Health Reg Issues. 2016; 9:15-21. DOI: 10.1016/j.vhri.2015.06.004. View

Husereau D, Drummond M, Augustovski F, De Bekker-Grob E, Briggs A, Carswell C . Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force. Value Health. 2022; 25(1):10-31. DOI: 10.1016/j.jval.2021.10.008. View

Chen Q, Lyu N, Wang X, Jiang X, Hu Y, Chen S . Cost-effectiveness and prognostic model of hepatic arterial infusion chemotherapy for hepatocellular carcinoma with high tumor burden and/or Vp4 tumor thrombus compared with sorafenib: a post-hoc analysis of the FOHAIC-1 trial. Int J Surg. 2023; 109(12):3929-3939. PMC: 10720800. DOI: 10.1097/JS9.0000000000000683. View

Wei J, Xu K, Lin Y, Liu Q, Zhou C, Zhang P . Economic evaluation of camrelizumab plus rivoceranib versus sorafenib as first-line therapy for unresectable hepatocellular carcinoma in the United States and China. Int J Clin Pharm. 2024; 46(5):1189-1199. DOI: 10.1007/s11096-024-01752-8. View

10.

Holder A, Dedeilia A, Sierra-Davidson K, Cohen S, Liu D, Parikh A . Defining clinically useful biomarkers of immune checkpoint inhibitors in solid tumours. Nat Rev Cancer. 2024; 24(7):498-512. DOI: 10.1038/s41568-024-00705-7. View

11.

Xie D, Shi J, Zhou J, Fan J, Gao Q . Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective. Clin Mol Hepatol. 2022; 29(2):206-216. PMC: 10121293. DOI: 10.3350/cmh.2022.0402. View

12.

Gong H, Ong S, Li F, Shen Y, Weng Z, Zhao K . Cost-effectiveness of immune checkpoint inhibitors as a first-line therapy for advanced hepatocellular carcinoma: a systematic review. Health Econ Rev. 2024; 14(1):48. PMC: 11225220. DOI: 10.1186/s13561-024-00526-2. View

13.

Greenhawt M, Oppenheimer J, Codispoti C . A Practical Guide to Understanding Cost-Effectiveness Analyses. J Allergy Clin Immunol Pract. 2021; 9(12):4200-4207. DOI: 10.1016/j.jaip.2021.10.006. View

14.

Jiang L, Zhao N, Xu M, Pei J, Lin Y, Yao Q . Incidence trends of primary liver cancer in different geographical regions of China from 1978 to 2012 and projections to 2032: An age-period-cohort analysis. Int J Cancer. 2023; 154(3):465-476. DOI: 10.1002/ijc.34724. View

15.

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

16.

Tseng C, Tsai Y, Shiu M . Cost-effectiveness analysis of atezolizumab plus bevacizumab versus sorafenib in first line treatment for Chinese subpopulation with unresectable hepatocellular carcinoma. Front Oncol. 2023; 13:1264417. PMC: 10663301. DOI: 10.3389/fonc.2023.1264417. View

17.

Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Niksic M . Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018; 391(10125):1023-1075. PMC: 5879496. DOI: 10.1016/S0140-6736(17)33326-3. View

18.

Kuo H, Khan K, Kerbel R . Antiangiogenic-immune-checkpoint inhibitor combinations: lessons from phase III clinical trials. Nat Rev Clin Oncol. 2024; 21(6):468-482. DOI: 10.1038/s41571-024-00886-y. View

19.

Llovet J, Castet F, Heikenwalder M, Maini M, Mazzaferro V, Pinato D . Immunotherapies for hepatocellular carcinoma. Nat Rev Clin Oncol. 2021; 19(3):151-172. DOI: 10.1038/s41571-021-00573-2. View

20.

Zhao M, Pan X, Yin Y, Hu H, Wei J, Bai Z . Cost-Effectiveness Analysis of Five Systemic Treatments for Unresectable Hepatocellular Carcinoma in China: An Economic Evaluation Based on Network Meta-Analysis. Front Public Health. 2022; 10:869960. PMC: 9051228. DOI: 10.3389/fpubh.2022.869960. View