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Cost-Effectiveness of Cabozantinib in the Second-Line Treatment of Advanced Hepatocellular Carcinoma

Enrique Soto-Perez-de-Celis1, Pedro N Aguiar2, Mónica L Cordón3

  • 1Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Journal of the National Comprehensive Cancer Network : JNCCN
|June 15, 2019
PubMed
Abstract

Insights

Cabozantinib offers improved overall survival for advanced hepatocellular carcinoma (HCC) patients post-sorafenib treatment. However, this study found cabozantinib not to be a cost-effective second-line therapy in the US at current pricing.

Area of Science:

  • Oncology
  • Health Economics
  • Pharmacoeconomics

Background:

  • Limited treatment options exist for advanced hepatocellular carcinoma (HCC) progressing after sorafenib.
  • Cabozantinib demonstrated improved overall survival (OS) in the CELESTIAL trial for such patients.
  • This study evaluates the cost-effectiveness of cabozantinib as a second-line HCC treatment from a US healthcare perspective.

Purpose of the Study:

  • To assess the cost-effectiveness of cabozantinib versus placebo plus best supportive care for second-line treatment of advanced HCC.
  • To determine the incremental cost-effectiveness ratio (ICER) for cabozantinib in this patient population.

Main Methods:

  • Cost and utility data were extracted from the CELESTIAL trial.
  • The incremental cost-effectiveness ratio (ICER) was calculated as cost per quality-adjusted life year (QALY) gained.
  • Sensitivity and cost-threshold analyses were performed.

Main Results:

  • The base-case analysis yielded an ICER of $1,040,675 per QALY gained for cabozantinib.
  • Overall survival (OS) from the CELESTIAL trial was the most influential factor on the ICER.
  • No scenarios in sensitivity analyses demonstrated cabozantinib to be cost-effective; a price reduction to $50/pill was estimated as necessary.

Conclusions:

  • Cabozantinib is not a cost-effective second-line therapy for advanced HCC in the United States at its current cost.
  • Despite improving OS, the high cost of cabozantinib limits its value in this treatment setting.

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