Cost-effectiveness of first-line immune checkpoint inhibitor therapies, alone or combined with targeted agents, for unresectable hepatocellular carcinoma in China: an economic evaluation using network meta-analysis.

[OBJECTIVES] This economic evaluation aimed to identify a cost-effective first-line treatment for unresectable hepatocellular carcinoma (uHCC) within China's healthcare system, specifically focusing on immune checkpoint inhibitor (ICI)-based regimens relevant to clinical practice, including newly approved options.

[METHODS] Relative efficacy was synthesized from six phase III trials forming a star-shaped network with sorafenib as the common comparator, using a Bayesian network meta-analysis with Royston-Parmar models, accounting for non-proportional hazards. A 10-year, three-state partitioned survival model estimated discounted (5% annually) costs and quality-adjusted life-years (QALYs). Sensitivity analyses tested structural and parameter uncertainty.

[RESULTS] After discounting, camrelizumab-rivoceranib provided more QALYs at a lower cost than three other ICI-based combinations (anlotinib-penpulimab, sintilimab-bevacizumab biosimilar, and toripalimab-bevacizumab), establishing strict dominance. The incremental cost per QALY gained was $10,715 for tislelizumab versus sorafenib, $56,796 for camrelizumab-rivoceranib versus tislelizumab, and $294,795 for atezolizumab-bevacizumab versus camrelizumab-rivoceranib. All findings remained robust in sensitivity analyses.

[CONCLUSIONS] For uHCC in China, tislelizumab represents a cost-effective choice at the current willingness-to-pay threshold of $40,344 per QALY (3×gross domestic product (GDP) per capita). This analysis provides timely evidence to inform clinical practice and policy decisions regarding the allocation of finite healthcare resources.