Camrelizumab plus rivoceranib versus sorafenib as first-line therapy for patients with unresectable hepatocellular carcinoma: A cost-utility analysis in China and the United States

Qiuling Zhao ¹ Yimin He ² Zilin Nian ² Liangliang Dong ^1* Yongjian Huang ² Ruyi Huang ¹ Lijun Lai ¹ Lin Yang ¹

• ¹ Fujian Provincial Cancer Hospital, Fuzhou, Fujian Province, China
• ² Fujian Medical University, Fuzhou, Fujian Province, China

AbstractObjective Camrelizumab plus rivoceranib (camr-rivo) can significantly improve overall survival (OS) for patients with unresectable or advanced hepatocellular carcinoma (HCC) in the CARES-310 trial. However, whether the treatment is economical remains unclear. Therefore, this study evaluated the cost-utility of camr-rivo versus sorafenib as first-line systemic therapy for unresectable or advanced HCC patients from the Chinese healthcare system perspective and the United States (US) payers' perspective. Methods According to the CARES-310 trial, a partitioned survival model was constructed to estimate economic costs and health outcomes over a 10-year lifetime horizon. Drug costs were obtained from public database, Red Book and literature. Health utility values data were derived from literature. One-way and probabilistic sensitivity analyses were performed. The willingness-to-pay (WTP) threshold was $36,627.25/QALY in China and $150,000.00/QALY in the US. Results The camr-rivo yielded additional 0.34 quality-adjusted life year (QALY) compared to sorafenib for unresectable or advanced HCC patients. The incremental costs in China and the US were $4,762.10 and $92,700.49, respectively, and the incremental cost-utility ratios (ICURs) were $14,174.40/QALY and $272,852.59/QALY, respectively. Sensitivity analyses indicated that the cost of rivoceranib and camrelizumab had the greatest impact on the ICUR in China and the US, respectively. Scenario analyses showed that the price reduced about 30% in camrelizumab and rivoceranib could make camr-rivo economical in the US. Conclusions At the set WTP, camr-rivo is a cost-utility treatment strategy compared with sorafenib as first-line therapy for patients with unresectable or advanced HCC in China but not in the US.