Cost-Effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib for HCC

Atezolizumab plus bevacizumab was not considered cost-effective compared with sorafenib for the treatment of unresectable or metastatic hepatocellular carcinoma (HCC), although associated with clinical benefit, according to a study published in JAMA Network Open (2021;4[4]:e214846. doi:10.1001/jamanetworkopen.2021.4846).

“Atezolizumab plus bevacizumab as a first-line therapy for patients with unresectable or metastatic hepatocellular carcinoma has been shown to improve overall and progression-free survival compared with standard sorafenib treatment,” wrote Xin Zhang, MD, department of hepatology and infectious diseases, Second Affiliated Hospital of Xi’an Jiaotong University, China, and colleagues.

“However, because of the high cost of atezolizumab plus bevacizumab, assessment of its value by considering both efficacy and cost is needed,” they added.

This study aimed to evaluate the cost-effectiveness of atezolizumab plus bevacizumab compared with sorafenib for patients with unresectable or metastatic HCC from a US Payer perspective.

A partitioned survival model was used to examine health care costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of the two regimens. One-way deterministic and probabilistic sensitivity analyses were used to examine model uncertainty.

In addition, the model was used to estimate price reductions of atezolizumab plus bevacizumab that would achieve more favorable cost-effectiveness.

A hypothetical sample of 424 patients were included in the base case analysis. Treatment with atezolizumab plus bevacizumab was associated with an increase of 0.623 LYs and 0.484 QALYs with an incremental cost of $156,210 per patient vs sorafenib. The ICER was $322,500 per QALY with a
0.6% probability of being cost-effective at a willingness-to-pay (WTP) threshold of $100,000 and 5.1% probability of being cost-effective at a WTP of $150,000 per QALY.

In one-way sensitivity analyses, the ICER never decreased below $150,000 per QALY. The price of atezolizumab plus bevacizumab would need to be reduced by 37% and 47% to achieve more favorable cost-effectiveness under a WTP of $150,000 and $100,000 per QALY, respectively.

“In this economic evaluation, atezolizumab plus bevacizumab was associated with clinical benefit but was not cost-effective compared with sorafenib for first-line treatment of unresectable or metastatic [HCC] from a US payer perspective,” wrote Dr Zhang and colleagues.

“A substantial reduction in price for atezolizumab plus bevacizumab would be needed to achieve favorable cost-effectiveness for this new therapy,” they concluded.—Janelle Bradley