Cost-effectiveness analysis of toripalimab plus bevacizumab as first-line therapy for advanced hepatocellular carcinoma

Background: The HEPATORCH trial demonstrated that toripalimab plus bevacizumab (TOR-BEV) offers superior survival outcomes for patients with advanced hepatocellular carcinoma (HCC) compared to sorafenib. However, the significantly higher costs of toripalimab and bevacizumab raise concerns about the cost-effectiveness of TOR-BEV. This study evaluates the cost-effectiveness of TOR-BEV as a first-line treatment for advanced HCC within the context of China's healthcare system, relative to sorafenib. Methods: A partitioned survival model with three health states was developed to compare the cost-effectiveness of TOR-BEV and sorafenib as first-line therapies for advanced HCC. Clinical data were sourced from the HEPATORCH trial. Drug costs were based on national tender prices, while other costs and utility parameters were obtained from the literature. The primary outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to assess the robustness of the results. Results: The TOR-BEV regimen generated 1.88 QALYs at a cost of $42,239.26, whereas sorafenib resulted in 1.43 QALYs at a cost of $11,201.54. The ICER for TOR-BEV compared to sorafenib was $69,231.90 per QALY gained, exceeding the predefined willingness-to-pay threshold of $40,365 per QALY. The probability of TOR-BEV being deemed cost-effective was only 1.5%. Key factors influencing the model outcomes included the utility value of progression-free survival, weight, the cost of bevacizumab, the utility value of progressive disease, and the cost of toripalimab. Conclusion: From the perspective of the Chinese healthcare system, TOR-BEV is unlikely to be cost-effective as a first-line treatment for advanced HCC compared to sorafenib unless the prices of both toripalimab and bevacizumab are reduced to below 50.1% of their current prices. However, this regimen was cost-effective in the subgroup of patients with an Eastern Cooperative Oncology Group performance status score of 1, and economic viability is also expected in highly developed regions such as Beijing.