The cost effectiveness of toripalimab plus bevacizumab versus sorafenib for the first-line treatment of advanced hepatocellular carcinoma in China.

[BACKGROUND] Supported by evidence of efficacy and safety from the landmark HEPATORCH trial, the combination therapy of toripalimab and bevacizumab (TORI + Bev) has been adopted into the Chinese Society of Clinical Oncology (CSCO) clinical guidelines for advanced hepatocellular carcinoma (HCC). The economic viability of this regimen, however, has yet to be assessed.

[METHODS] This economic evaluation used a partitioned survival model (PartSA) over a 10-year horizon. Overall survival data from the HEPATORCH trial were incorporated into the model to compare the cost-effectiveness of first-line TORI plus bevacizumab (TORI + Bev) sorafenib in advanced hepatocellular carcinoma (HCC). Cost inputs were limited to direct medical expenditures: drug prices were obtained from the National Drug Price Database of Yaozh.com, and other cost and utility parameters were sourced from published literature. Considering the unique characteristics of China's centralized drug procurement policy and the substantial price differences between originator and generic drugs within the same therapeutic class, this study stratify analysis by originator vs. generic scenarios separately. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to evaluate the robustness of the model results.

[RESULTS] Compared with sorafenib, the TORI plus bevacizumab regimen demonstrated greater health benefits (1.62 QALYs vs. 1.27 QALYs). However, due to its higher treatment costs, the incremental cost-effectiveness ratio (ICER) for TORI plus bevacizumab reached $67,352.09 per QALY under originator pricing and $65,300.63 per QALY under generic pricing. Probabilistic sensitivity analysis indicated that, when using three times China's GDP ($40,723.4) as the cost-effectiveness threshold, the probability of TORI plus bevacizumab being cost-effective was 9.2% for originator pricing and 9.1% for generic pricing.

[CONCLUSION] TORI + Bev is unlikely to be cost effective compared with sorafenib for the first-line treatment of advanced HCC in China. Reducing the price of bevacizumab can increase the possibility of it being cost effective in the future.