Sorafenib not a cost-effective treatment option in locally advanced hepatocellular carcinoma

Abstract

Sorafenib is not a cost-effective treatment option, compared with selective internal radiotherapy (SIRT) with Yttrium-90, in locally advanced hepatocellular carcinoma (HCC), according to a study from the US. The study used a state-transition microsimulation model to assess the cost effectiveness of SIRT versus sorafenib in locally advanced, inoperable HCC from a US healthcare sector perspective. The model was based on pooled individual patient survival data generated from two recently published, large, randomised phase III trials (SARAH* and SIRveNIB**). The model showed that sorafenib was associated with slightly more average quality-adjusted life-years (QALYs) than SIRT (0.88 vs 0.87) at substantially higher average costs ($US78 859 vs $58 397; year 2016/2017 values) over a 5-year time horizon. The incremental cost-effectiveness ratio (ICER) for sorafenib at its current price versus SIRT was $1 280 224/QALY. Sensitivity analyses showed that the ICER for sorafenib would only fall below $200 000/QALY when the monthly price of sorafenib was reduced from $16 390 to < $7000, a decrease of > 50%. Modelling the SARAH and SIRveNIB trials separately resulted in different incremental QALYs associated with sorafenib versus SIRT (–0.01 and +0.06, respectively). Consequently, SIRT was the dominant strategy based on data from the SARAH trial only, and the ICER for sorafenib versus SIRT based on data from the SIRveNIB trial was $743 412/QALY. Sorafenib is unlikely to provide a gain in quality-adjusted survival compared with SIRT in locally advanced HCC at a cost considered to be acceptable according to current US cost-effectiveness thresholds, conclude the researchers.