Cost-effectiveness analysis of systemic therapies for advanced hepatocellular carcinoma.

606 Background: The management of unresectable and metastatic HCC has evolved over the years with the introduction of immunotherapy. Currently, three FDA-approved first-line treatment combinations are available: ipilimumab plus nivolumab (ipi+nivo), atezolizumab plus bevacizumab (atezo+bev), and durvalumab plus tremelimumab (durva+trem). We evaluated the cost-effectiveness of ipi+nivo combination therapy compared to atezo+bev, durva+trem, and sorafenib. Methods: We assessed the long-term costs and quality-adjusted life years (QALYs) for ipi+nivo using a partitioned survival analysis by simulating patient outcomes over a 10-year time horizon based on published survival curves from the CheckMate 9DW trial. Cost inputs for ipi+nivo were obtained from previously published data on its use in melanoma. We calculated the incremental cost-effectiveness ratios (ICERs) for each of the treatment combinations by comparing ipi+nivo simulation results to published cost effectiveness estimates of atezo+bev, durva+trem, and sorafenib. Results: Over 10 years, ipi+nivo had an average cost of 308, 616 and 2. 25 QALYs (Table 1). Ipi+nivo had a 22, 623 per additional QALY (0. 7 QALYs gained) compared to atezo+bev, 85, 889 per additional QALY (1. 23 QALYs gained) compared to sorafenib, and 239, 444 per additional QALY (0. 5 QALYs gained) compared to durva+trem. Conclusions: Preliminary results suggest that ipi + nivo combination therapy is a cost-effective treatment option for hepatocellular carcinoma, although durva+trem appears dominant. Further sensitivity analyses and longer-term survival data of each regimen collected under comparable settings are needed to confirm these findings. Comparison of life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) relative to sorafenib. Strategy Total LYs Total QALYs Total cost () ICER (/QALY) Ipi+Nivo 3. 28 2. 25 308, 616 85, 889 Atezo+Bev 3. 03 1. 55 292, 780 169, 447 Durva+Trem 2. 47 1. 75 188, 894 -19, 286 Sorafenib 1. 74 1. 02 202, 973 -