Cost-utility analysis of atezolizumab combined with bevacizumab for unresectable hepatocellular carcinoma in Thailand
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Issued Date
2024-03-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85188342736
Pubmed ID
38512900
Journal Title
PLoS ONE
Volume
19
Issue
3 March
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.19 No.3 March (2024)
Suggested Citation
Sriphoosanaphan S., Pantumongkol W., Kulpeng W., Charonpongsuntorn C., Tanwandee T., Sukeepaisarnjaroen W., Sobhonslidsuk A., Tangkijvanich P. Cost-utility analysis of atezolizumab combined with bevacizumab for unresectable hepatocellular carcinoma in Thailand. PLoS ONE Vol.19 No.3 March (2024). doi:10.1371/journal.pone.0300327 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/97837
Title
Cost-utility analysis of atezolizumab combined with bevacizumab for unresectable hepatocellular carcinoma in Thailand
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Clinical trials have proven the efficacy and safety of atezolizumab combined with bevacizumab (A+B) in treating unresectable hepatocellular carcinoma (uHCC). This study aimed to assess the cost-utility of A+B compared to best supportive care (BSC) among uHCC patients in Thailand. Methods We conducted a cost-utility analysis from a societal perspective. We used a three-state Markov model to estimate relevant costs and health outcomes over the lifetime horizon. Local cost and utility data from Thai patients were applied. All costs were adjusted to 2023 values using the consumer price index. We reported results as incremental cost-effectiveness ratios (ICERs) in United States dollars ($) per quality-adjusted life year (QALY) gained. We discounted future costs and outcomes at 3% per annum. We then performed one-way sensitivity analysis and probabilistic sensitivity analysis to assess parameter uncertainty. The budget impact was conducted to estimate the financial burden from the governmental perspective over a five-year period. Results Compared to BSC, A+B provided a better health benefit with 0.8309 QALY gained at an incremental lifetime cost of $45,357. The ICER was $54,589 per QALY gained. The result was sensitive to the hazard ratios for the overall survival and progression-free survival of A +B. At the current Thai willingness-to-pay (WTP) threshold of $4,678 per QALY gained, the ICER of A+B remained above the threshold. The projected budgetary requirements for implementing A+B in the respective first and fifth years would range from 8.2 to 27.9 million USD. Conclusion Although A+B yielded the highest clinical benefit compared with BSC for the treatment of uHCC patients, A+B is not cost-effective in Thailand at the current price and poses budgetary challenges.