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

• Published in: Health economics review Vol. 14; no. 1; pp. 48 - 16
• Main Authors: Gong, Hongyu, Ong, Siew Chin, Li, Fan, Shen, Yan, Weng, Zhiying, Zhao, Keying, Jiang, Zhengyou, Wang, Meng
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 05.07.2024; Springer Nature B.V; BMC
• Subjects: Advanced hepatocellular carcinoma; Cost analysis; Cost-effectiveness; Health Care Management; Health Economics; Health Services Research; Health technology assessment; Immune checkpoint inhibitors; Liver cancer; Medicine; Medicine & Public Health; Pharmacoeconomics and Health Outcomes; Public Finance; Public Health; Review; Systematic review; Advanced hepatocellular carcinoma; Systematic review; Immune checkpoint inhibitors; Health technology assessment; Cost-effectiveness
• ISSN: 2191-1991; 2191-1991
• DOI: 10.1186/s13561-024-00526-2

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.