Cost-effectiveness of Camrelizumab Plus Rivoceranib Versus Sorafenib As First-line Treatment of Unresectable Hepatocellular Carcinoma

Overview

Journal Therap Adv Gastroenterol

Publisher Sage Publications

Specialty Gastroenterology

Date 2025 Jan 6

PMID 39758963

Authors

Huimin Zou

Yunfeng Lai

Xianwen Chen

Carolina Oi Lam Ung

Hao Hu

Affiliations

Soon will be listed here.

Abstract

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality globally. Recent advancements in targeted therapies have improved outcomes for advanced HCC, yet therapeutic options remain limited. The CARES-310 trial demonstrated that camrelizumab plus rivoceranib significantly improves survival compared to sorafenib for advanced HCC.

Objectives: This study aimed to evaluate the cost-effectiveness of camrelizumab plus rivoceranib as a first-line treatment for unresectable HCC from the Chinese health system perspective.

Design: The cost-effectiveness analysis.

Methods: A partitioned survival model was constructed to estimate clinical and economic outcomes for patients with unresectable or metastatic HCC. The model included three health states: progression-free, progression disease, and death. The hypothetical cohort consisted of patients aged ⩾18 with HCC who had not received systemic therapy, reflecting the CARES-310 trial. Clinical data were derived from the CARES-310 trial and extrapolated using standard parameter distributions. Direct medical costs and utilities were sourced from the CARES-310 trial and published literature.

Results: The 10-year cost of camrelizumab plus rivoceranib was higher than sorafenib (USD 28,148.01 vs USD 20,997.86). Camrelizumab plus rivoceranib yielded an additional 0.26 quality-adjusted life-years (QALYs) with an incremental cost of USD 7150.15, resulting in an incremental cost-effectiveness ratio of USD 27,633.75/QALY. Sensitivity analyses confirmed the robustness of the base-case results.

Conclusion: Camrelizumab plus rivoceranib is likely a cost-effective first-line treatment for unresectable HCC from a Chinese health system perspective. This study highlights the need for additional real-world data to validate these findings and guide clinical decision-making for HCC.

References

Zhou T, Wang X, Cao Y, Yang L, Wang Z, Ma A . Cost-effectiveness analysis of sintilimab plus bevacizumab biosimilar compared with lenvatinib as the first-line treatment of unresectable or metastatic hepatocellular carcinoma. BMC Health Serv Res. 2022; 22(1):1367. PMC: 9673291. DOI: 10.1186/s12913-022-08661-4. View

Sun B, Xu L, Bi W, Ou W . SALL4 Oncogenic Function in Cancers: Mechanisms and Therapeutic Relevance. Int J Mol Sci. 2022; 23(4). PMC: 8876671. DOI: 10.3390/ijms23042053. View

Donisi C, Puzzoni M, Ziranu P, Lai E, Mariani S, Saba G . Immune Checkpoint Inhibitors in the Treatment of HCC. Front Oncol. 2021; 10:601240. PMC: 7874239. DOI: 10.3389/fonc.2020.601240. View

Guyot P, Ades A, Ouwens M, Welton N . Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves. BMC Med Res Methodol. 2012; 12:9. PMC: 3313891. DOI: 10.1186/1471-2288-12-9. View

Forner A, Reig M, Bruix J . Hepatocellular carcinoma. Lancet. 2018; 391(10127):1301-1314. DOI: 10.1016/S0140-6736(18)30010-2. View

Zou H, Xue Y, Chen X, Lai Y, Yao D, Ung C . Comparative analysis of disease modelling for health economic evaluations of systemic therapies in advanced hepatocellular carcinoma. PLoS One. 2023; 18(10):e0292239. PMC: 10553296. DOI: 10.1371/journal.pone.0292239. 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

Lang W, Deng L, Huang B, Zhong D, Zhang G, Lu M . Cost-Effectiveness Analysis of Camrelizumab Plus Rivoceranib Versus Sorafenib as a First-Line Therapy for Unresectable Hepatocellular Carcinoma in the Chinese Health Care System. Clin Drug Investig. 2024; 44(3):149-162. DOI: 10.1007/s40261-024-01343-5. View

Qin S, Chan S, Gu S, Bai Y, Ren Z, Lin X . Camrelizumab plus rivoceranib versus sorafenib as first-line therapy for unresectable hepatocellular carcinoma (CARES-310): a randomised, open-label, international phase 3 study. Lancet. 2023; 402(10408):1133-1146. DOI: 10.1016/S0140-6736(23)00961-3. View

10.

Su D, Wu B, Shi L . Cost-effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib as First-Line Treatment of Unresectable Hepatocellular Carcinoma. JAMA Netw Open. 2021; 4(2):e210037. PMC: 7905498. DOI: 10.1001/jamanetworkopen.2021.0037. View

11.

Zhang X, Wang J, Shi J, Jia X, Dang S, Wang W . Cost-effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib for Patients With Unresectable or Metastatic Hepatocellular Carcinoma. JAMA Netw Open. 2021; 4(4):e214846. PMC: 8027915. DOI: 10.1001/jamanetworkopen.2021.4846. View

12.

Sangro B, Sarobe P, Hervas-Stubbs S, Melero I . Advances in immunotherapy for hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol. 2021; 18(8):525-543. PMC: 8042636. DOI: 10.1038/s41575-021-00438-0. View

13.

Vanneman M, Dranoff G . Combining immunotherapy and targeted therapies in cancer treatment. Nat Rev Cancer. 2012; 12(4):237-51. PMC: 3967236. DOI: 10.1038/nrc3237. View

14.

Mahipal A, Tella S, Kommalapati A, Lim A, Kim R . Immunotherapy in Hepatocellular Carcinoma: Is There a Light at the End of the Tunnel?. Cancers (Basel). 2019; 11(8). PMC: 6721326. DOI: 10.3390/cancers11081078. View

15.

Kudo M, Finn R, Qin S, Han K, Ikeda K, Piscaglia F . Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018; 391(10126):1163-1173. DOI: 10.1016/S0140-6736(18)30207-1. View

16.

Benson A, DAngelica M, Abbott D, Anaya D, Anders R, Are C . Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021; 19(5):541-565. DOI: 10.6004/jnccn.2021.0022. View

17.

Sun C, Lan P, Han Q, Huang M, Zhang Z, Xu G . Oncofetal gene SALL4 reactivation by hepatitis B virus counteracts miR-200c in PD-L1-induced T cell exhaustion. Nat Commun. 2018; 9(1):1241. PMC: 5871883. DOI: 10.1038/s41467-018-03584-3. View

18.

Zhou T, Cao Y, Wang X, Yang L, Wang Z, Ma A . Economic Evaluation of Sintilimab Plus Bevacizumab Versus Sorafenib as a First-line Treatment for Unresectable Hepatocellular Carcinoma. Adv Ther. 2022; 39(5):2165-2177. DOI: 10.1007/s12325-022-02079-4. View

19.

Woods B, Sideris E, Palmer S, Latimer N, Soares M . Partitioned Survival and State Transition Models for Healthcare Decision Making in Oncology: Where Are We Now?. Value Health. 2020; 23(12):1613-1621. DOI: 10.1016/j.jval.2020.08.2094. View

20.

. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1859-1922. PMC: 6252083. DOI: 10.1016/S0140-6736(18)32335-3. View