Related Experiment Video
Updated: Dec 5, 2025
12:24
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
5.8K
Sequencing Systemic Therapy Pathways for Advanced Hepatocellular Carcinoma: A Cost Effectiveness Analysis
Christopher Sherrow1, Kristopher Attwood2, Kehua Zhou3
1Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Liver Cancer
|October 21, 2020
Summary
The most cost-effective treatment for advanced liver cancer (HCC) involves first-line tyrosine kinase inhibitors followed by second-line immunotherapy. While all evaluated treatment pathways exceeded typical willingness-to-pay thresholds, this sequence offers the best value.
Area of Science:
- Hepatocellular Carcinoma (HCC) Treatment
- Health Economics and Outcomes Research
- Oncology Drug Efficacy and Cost
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally with limited treatment options.
- Sorafenib was historically the sole systemic therapy for advanced HCC; however, recent FDA approvals have introduced six new agents.
- Current clinical guidelines lack clear direction on optimal sequencing for these novel HCC therapies.
Purpose of the Study:
- To conduct a comprehensive cost-effectiveness analysis (CEA) of various first- and second-line treatment sequences for advanced HCC.
- To evaluate the cost-effectiveness of newly approved systemic therapies for HCC.
- To provide clinical guidance on the most cost-effective treatment pathways for HCC.
Main Methods:
- Markov models were employed to assess eight distinct first- and second-line treatment sequences for HCC.
- Cost-effectiveness ratios (CER) and incremental CER (ICER) were calculated against willingness-to-pay (WTP) thresholds.
- Efficacy, toxicity, and wholesale acquisition costs (WAC) of agents (excluding ramucirumab) were analyzed using data from landmark trials and June 2019 pricing; Monte-Carlo simulations modeled 1,000,000 patients.
Main Results:
- The sorafenib-only pathway exhibited the lowest cost-effectiveness ratio (CER), followed by pembrolizumab at $227,741.03 per quality-adjusted life year (QALY).
- Incremental cost-effectiveness ratio (ICER) analysis indicated that second-line pembrolizumab-based pathways become cost-effective at a higher WTP threshold of $300,000/QALY.
- Sensitivity analyses confirmed the robustness of these findings, showing no substantial changes to the results.
Conclusions:
- The optimal cost-effective strategy identified was first-line tyrosine kinase inhibitor (TKI) therapy followed by second-line immunotherapy.
- All evaluated HCC treatment pathways surpassed the commonly accepted WTP threshold of $100,000-$150,000/QALY.
- Further research is recommended to refine these findings and inform real-world clinical practice for advanced HCC management.
Related Concept Videos
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
100
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
100
02:57Targeted Cancer Therapies
8.3K
The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
There are several types of targeted therapies against...
8.3K
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
122
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
122