Cost-effectiveness analysis of durvalumab combined with tremelimumab versus sorafenib as first-line treatment for unresectable Hepatocellular carcinoma in China: a dual-model approach utilizing partitioned survival and markov models

Background Hepatocellular carcinoma (HCC) is a major contributor to global cancer-related mortality, with the majority of patients diagnosed at unresectable stages. The STRIDE regimen (tremelimumab plus durvalumab) demonstrated superior survival benefits over sorafenib in the HIMALAYA trial. However, its cost-effectiveness within the Chinese healthcare system remains unverified. Objective To evaluate the cost-effectiveness of first-line STRIDE versus sorafenib for unresectable HCC from the perspective of the Chinese healthcare payer. Methods A comprehensive cost-effectiveness analysis was conducted using both partitioned survival (PartSA) and Markov state-transition models over a 10-year time horizon. Clinical efficacy parameters were derived from reconstructed HIMALAYA trial survival data. Direct medical costs were estimated based on post-negotiation drug pricing in China and published sources. Health utility weights were sourced from established literature. Scenario analyses (50% price reduction, 0% discount rate) and comprehensive deterministic and probabilistic sensitivity analyses (PSA) were performed to evaluate model uncertainty. Results In the base-case analysis, the STRIDE regimen yielded incremental cost-effectiveness ratios (ICERs) of $204,713.55/QALY in the PartSA model and $208,385.86/QALY in the Markov model, both substantially exceeding China’s willingness-to-pay threshold (3× GDP per capita, $36,975/QALY). Under a 50% price reduction scenario, the ICER dropped to $87,351.95/QALY but remained non-cost-effective. Probabilistic sensitivity analysis demonstrated a < 20% likelihood of STRIDE being cost-effective across tested scenarios. Key cost drivers included drug acquisition costs and progression-free utility values. Conclusion Under current pricing, the STRIDE regimen is not cost-effective as a first-line treatment for unresectable HCC in China. While price concessions improve affordability, exploration of value-based pricing and future biomarker-guided patient stratification could be evaluated to optimize economic viability. The dual-model concordance reinforces the robustness of these findings.