Cost-effectiveness of immune checkpoint inhibitors as a first-line therapy for advanced hepatocellular carcinoma: a systematic review

Hongyu Gong, Siew Chin Ong (), Fan Li, Yan Shen, Zhiying Weng, Keying Zhao, Zhengyou Jiang and Meng Wang
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Hongyu Gong: Kunming Medical University
Siew Chin Ong: Universiti Sains Malaysia
Fan Li: Kunming Medical University
Yan Shen: Yunnan Cancer Hospital
Zhiying Weng: Kunming Medical University
Keying Zhao: Kunming Medical University
Zhengyou Jiang: Universiti Sains Malaysia
Meng Wang: Physical Examination Center, Kunming Center for Disease Prevention and Control

Health Economics Review, 2024, vol. 14, issue 1, 1-16

Abstract: Abstract Since 2017, immune checkpoint inhibitors (ICIs) have been available for the treatment of advanced hepatocellular carcinoma (HCC) or unresectable HCC, but their adoption into national medical insurance programs is still limited. Cost-effectiveness evidence can help to inform treatment decisions. This systematic review aimed to provide a critical summary of economic evaluations of ICIs as a treatment for advanced HCC and identify key drivers (PROSPERO 2023: CRD42023417391). The databases used included Scopus, Web of Science, PubMed, Embase, and Cochrane Central. Economic evaluations of ICIs for the treatment of advanced HCC were included. Studies were screened by two people. Of the 898 records identified, 17 articles were included. The current evidence showed that ICIs, including atezolizumab plus bevacizumab, sintilimab plus bevacizumab/bevacizumab biosimilar, nivolumab, camrelizumab plus rivoceranib, pembrolizumab plus lenvatinib, tislelizumab, durvalumab, and cabozantinib plus atezolizumab, are probably not cost-effective in comparison with tyrosine kinase inhibitors or other ICIs. The most influential parameters were price of anticancer drugs, hazard ratios for progression-free survival and overall survival, and utility for health statest. Our review demonstrated that ICIs were not a cost-effective intervention in advanced HCC. Although ICIs can significantly enhance the survival of patients with advanced HCC, decision-makers should consider the findings of economic evaluations and affordability before adoption of new therapies.

Keywords: Cost-effectiveness; Health technology assessment; Immune checkpoint inhibitors; Advanced hepatocellular carcinoma; Systematic review (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1186/s13561-024-00526-2

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