Atezolizumab plus bevacizumab versus nivolumab as first-line treatment for advanced or unresectable hepatocellular carcinoma: A cost-effectiveness analysis

Background The cost effectiveness of atezolizumab plus bevacizumab (atezo-beva) versus nivolumab treatment for advanced or unresectable hepatocellular carcinoma is still uncertain. In this study, the cost effectiveness of these treatments was assessed in the United States. Methods A cost-effectiveness analysis integrating a network meta-analysis framework was performed using data from the IMbrave150 ( identifier NCT03434379) and CheckMate 459 ( identifier NCT02576509) trials. In total, 1244 patients were enrolled. A partitioned survival model was used to evaluate cost effectiveness. A deterministic one-way sensitivity analysis and probabilistic sensitivity analyses were further performed to evaluate model robustness. Subgroup analyses were also performed. Results Compared with the outcomes using nivolumab, the hazard ratio (HR) for overall survival with atezo-beva was 0.68 (95% CI, 0.48-0.98), and the HR for progression-free survival was 0.63 (95% CI, 0.47-0.85). Atezo-beva treatment was associated with an increase of 1.13 life-years and an increase of 0.69 quality-adjusted life-years (QALYs), as well as a $78,280 increase in cost per patient. The incremental cost-effectiveness ratio was $113,892 per QALY. The incremental net health benefit and the incremental net monetary benefit were 0.17 QALYs and $24,770, respectively, at a willingness-to-pay (WTP) threshold of $150,000 per QALY. The model was most sensitive to the HR for progression-free survival. The probability of atezo-beva being considered cost effective was 78%, and it was >50% in most of the subgroups at the WTP threshold of $150,000 per QALY. Conclusions At a WTP threshold of $150,000 per QALY and under current drug pricing, atezo-beva is likely considered cost-effective as a first-line treatment for advanced or unresectable hepatocellular carcinoma compared with nivolumab.