Cost-effectiveness analysis of toripalimab plus bevacizumab versus sorafenib as first-line treatment for advanced hepatocellular carcinoma in China

Zhengxiong Li^1*Jing He²Kai Ma^1*

• ¹School of Medicine Information and Engineering , Xuzhou Medical University, Xuzhou, China
• ²School of Medicine, University of Electronic Science and Technology of China Chengdu, Chengdu, China

Background: The HEPATORCH trial demonstrated that toripalimab combined with bevacizumab significantly prolonged progression-free survival and overall survival in patients with advanced hepatocellular carcinoma (HCC), with an acceptable safety profile. However, its economic implications remain unclear. This study aimed to evaluate the cost-effectiveness of toripalimab plus bevacizumab versus sorafenib monotherapy as first-line treatment for advanced HCC from the Chinese healthcare system perspective. Methods: Using clinical data from the HEPATORCH trial, a three-state partitioned survival model was constructed to assess the cost-effectiveness of the two treatment strategies over a 10-year horizon. Cost and utility inputs were derived from the publicly available data and published literature. Primary outcomes included total costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Scenario analysis, one-way and probabilistic sensitivity analyses (PSA) were performed to evaluate model robustness. Result: Base-case analysis demonstrated that the toripalimab-bevacizumab combination and sorafenib monotherapy incurred total costs of $44,994.43 and $35,014.79, yielding 2.26 LYs and 1.79 LYs, and 1.57 QALYs and 1.16 QALYs, respectively. The toripalimab plus bevacizumab regimen provided an This is a provisional file, not the final typeset article additional 0.41 QALYs at an incremental cost of $9,979.63, resulting in an ICER of $24,602.67/QALY. The ICER was significantly lower than the willingness-to-pay (WTP) threshold of three times China's per capita gross domestic product ($40,334/QALY). Scenario analyses confirmed the robustness of the base-case results. One-way sensitivity analysis revealed that the cost of bevacizumab and the proportion of patients receiving subsequent therapy in the sorafenib group were the most influential parameters on the ICERs. PSA indicated a 95.76% probability of toripalimab combined with bevacizumab being cost-effective at the WTP threshold of $40,334 per QALY. Conclusion: Compared with sorafenib, toripalimab plus bevacizumab is likely a cost-effective first-line treatment option for advanced HCC in China.