Cost-effectiveness analysis of first-line treatment for advanced soft tissue sarcomas in China

To evaluate the cost-effectiveness of four first-line treatment strategies-anlotinib, pazopanib, regorafenib, and conventional chemotherapy-for patients with advanced soft tissue sarcomas (STSs) in China.

A partitioned survival model was developed to simulate costs and quality-adjusted life years (QALYs) over a lifetime horizon from the Chinese healthcare system perspective. Relative treatment efficacies were derived from a network meta-analysis (NMA). Costs, sourced from local databases, and health utilities, obtained from the Sarcoma Treatment and Burden of Illness in North America and Europe (SABINE) study, were incorporated. A series of sensitivity and scenario analyses were performed to assess model robustness.

In the base-case analysis, the outcomes were as follows: chemotherapy yielded 0.76 QALYs at a cost of 76,052 CNY; pazopanib yielded 0.74 QALYs at 108,790 CNY; regorafenib yielded 0.79 QALYs at 113,500 CNY; and anlotinib yielded 0.73 QALYs at 81,812 CNY. The incremental cost-effectiveness ratio (ICER) for regorafenib relative to chemotherapy was 1,738,024 CNY per QALY gained, substantially exceeding China's willingness-to-pay (WTP) threshold. Sensitivity analyses confirmed the robustness of these findings.

Conventional chemotherapy, specifically using doxorubicin injection, represents the most cost-effective first-line treatment for advanced STS. However, this conclusion is sensitive to the chemotherapy composition; if the more expensive liposomal doxorubicin is used, anlotinib emerges as the preferred cost-effective option.