Compared with selective internal radiotherapy (SIRT), sorafenib is not unlikely cost-effective for hepatocellular carcinoma (HCC) in the United States (JCO Oncol Pract. 2021;OP2000443. doi:10.1200/OP.20.00443).
Recent trials revealed that there was no statistically significant difference in overall survival for selective internal radiotherapy with yttrium-90 vs sorafenib in locally advanced HCC.
“Given the high cost of both treatments, we investigated their comparative cost-effectiveness from a US health care sector perspective,” wrote Kathryn E Marqueen, MD, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, and colleagues.
A state-transition microsimulation model was developed to simulate patients assigned to SIRT or sorafenib according to an intention-to-treat principle.
Hazard rates for disease progression and death were based on Kaplan-Meier curves from the sorafenib vs radioembolization in advanced HCC (SARAH) and selective internal radiation therapy vs sorafenib in locally advanced HCC (SIRveNIB) trials. In addition, adverse events, treatment adherence, and quality of life were derived using data from these trials.
Medicare reimbursement rates and literature were used for determining cost. A probabilistic sensitivity analysis was conducted to estimate costs and quality-adjusted life years (QALYs) over a 5-year period.
A cost difference of over $20,000 was estimated between sorafenib ($78,859) and SIRT ($58,397). QALYs were .88 and .87, respectively. The incremental cost-effectiveness ratio (ICER) of sorafenib was $1,280,224/QALY, exceeding the assumed threshold of up to $200,000/QALY.
The monthly price of sorafenib would need to be below $7000 for the ICER to fall below $200k/QALY. In order to achieve an ICER <$100k/QALY, the monthly price of sorafenib would have to be below $6600.
“Sorafenib is unlikely to provide a gain in quality-adjusted survival compared with SIRT at an acceptable cost for the US healthcare sector,” concluded Dr Marqueen and colleagues.
“Only if the current price decreased by more than 50% would sorafenib be considered economically attractive,” they added.—Marta Rybczynski