2 For more than a decade, the availability of new agents, such as lenvatinib- and sorafenib-based targeted therapy, has significantly improved the outcomes of patients with advanced HCC, increasing the median overall survival (OS) to 10 to 15 months. 1 This statistic occurs partly because only 30% to 40% of all patients receive a diagnosis at early stages that are amenable to potentially curative treatments. Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide, accounting for 8.9% of the disease burden of all neoplasms. The economic outcomes also may be improved by tailoring treatments based on individual patient factors. Reducing the prices of atezolizumab and bevacizumab may improve cost-effectiveness. The subgroup analysis found that treatment with atezolizumab plus bevacizumab was associated with preferred incremental net health benefits in several subgroups, including patients with hepatitis B and C.Ĭonclusions and Relevance Atezolizumab plus bevacizumab treatment is unlikely to be a cost-effective option compared with sorafenib for patients with unresectable hepatocellular carcinoma. One-way sensitivity analysis revealed that the results were most sensitive to the hazard ratio of overall survival. The probabilistic sensitivity analysis indicated that treatment with atezolizumab plus bevacizumab achieved a 35% probability of cost-effectiveness at a threshold of $150 000/QALY. The incremental net health benefit was −0.068 QALYs, and the incremental net monetary benefit was −$10 202 at a willingness-to-pay threshold of $150 000/QALY. Results Treatment of hepatocellular carcinoma with atezolizumab plus bevacizumab added 0.530 QALYs and resulted in an incremental cost of $89 807 compared with sorafenib therapy, which had an incremental cost-utility ratio of $169 223 per QALY gained. Subgroup, 1-way sensitivity, and probabilistic sensitivity analyses were performed. Main Outcomes and Measures Costs, quality-adjusted life-years (QALYs), incremental cost-utility ratios, incremental net health benefits, and incremental net monetary benefits were calculated for the 2 treatment strategies. Key clinical data were generated from the IMbrave150 trial conducted between March 15, 2018, and January 30, 2019, and cost and health preference data were collected from the literature. The characteristics of patients in the model were similar to patients in a phase 3, open-label randomized clinical trial (IMbrave150) who had unresectable hepatocellular carcinoma and had not previously received systemic treatment. Objective To evaluate the cost-effectiveness of atezolizumab plus bevacizumab to treat unresectable hepatocellular carcinoma from the US payer perspective.ĭesign, Setting, and Participants This economic evaluation used a partitioned survival model consisting of 3 discrete health states to assess the cost-effectiveness of treatment of hepatocellular carcinoma with atezolizumab plus bevacizumab vs sorafenib. However, to our knowledge, the cost-effectiveness of using this high-priced therapy for this indication is currently unknown. Importance Treatment with atezolizumab plus bevacizumab may prolong overall survival among patients with unresectable hepatocellular carcinoma. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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