KEY TAKEAWAYS
- Sintilimab plus bevacizumab biosimilar is a promising first-line treatment option for patients with unresectable or metastatic HCC in the ORIENT-32 and REFLECT studies in Phase 3 Trial.
- A lifetime partitioned survival model was used to conduct a cost-effectiveness analysis of sintilimab plus bevacizumab biosimilar compared with lenvatinib for advanced HCC.
- The combination therapy with sintilimab and bevacizumab biosimilar resulted in an additional 0.493 QALYs at a higher cost than lenvatinib.
- The ICER for sintilimab plus bevacizumab biosimilar was $24,462 per QALY in the base-case analysis, sensitive to the utility of post-progression and the cost of bevacizumab biosimilar.
Recently developed programmed cell death protein-1 inhibitors, such as sintilimab, have considerably increased overall lifetime for patients with unresectable or metastatic hepatocellular carcinoma (HCC); nevertheless, the cost-effectiveness of sintilimab is unknown. Therefore, this research aimed to evaluate the financial viability of sintilimab with bevacizumab biosimilar against lenvatinib for the initial treatment of patients with unresectable or metastatic HCC.
Using a lifetime partitioned survival model, the cost-effectiveness analysis of sintilimab plus bevacizumab biosimilar against lenvatinib for advanced HCC in the Chinese healthcare system. The ORIENT-32 and REFLECT investigations, 2 recent randomized clinical trials, provided the results on clinical efficacy and safety. Previous research was consulted for their utility information. In addition, quality-adjusted life years (QALYs) and direct medical expenses over the long term were estimated. Finally, deterministic and probabilistic sensitivity assessments were conducted to ensure the model’s stability.
Sintilimab and bevacizumab biosimilar combination therapy resulted in an extra 0.493 QALYs at a greater cost ($33,102 vs. $21,037) than lenvatinib monotherapy (2021 US dollars). This caused the incremental cost-effectiveness ratio (ICER) $24,462/QALY in the base case analysis, which is deterministic. The post-progression value and the price of the biosimilar bevacizumab affected the ICERs significantly. Reducing the bevacizumab biosimilar dose from 15 mg to 7.5 mg per kilogram resulted in a lower estimated ICER. According to the probabilistic sensitivity analysis, the likelihood that sintilimab treatment is cost-effectively ranged from 11.6% at a WTP threshold of $12,500 to $37,547 (three times China’s GDP per capita).
When the willingness-to-pay (WTP) threshold is greater than $23,650, the combination of sintilimab and bevacizumab biosimilar is expected to be a cost-effective treatment option for unresectable or metastatic HCC in China.
Source: https://pubmed.ncbi.nlm.nih.gov/36397064/
Clinical trial: https://clinicaltrials.gov/ct2/show/NCT01761266/
Zhou T, Wang X, Cao Y, Yang L, Wang Z, Ma A, Li H. Cost-effectiveness analysis of sintilimab plus bevacizumab biosimilar compared with lenvatinib as the first-line treatment of unresectable or metastatic hepatocellular carcinoma. BMC Health Serv Res. 2022 Nov 17;22(1):1367. doi: 10.1186/s12913-022-08661-4. PMID: 36397064; PMCID: PMC9673291.
