ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1634266
This article is part of the Research TopicImmunology and Therapeutic Innovations in Hepatocellular Carcinoma: Exploring Immune Evasion and BeyondView all 11 articles
Economic Evaluation of Anlotinib Plus Penpulimab Versus Sorafenib as First-Line Therapy for Unresectable Hepatocellular Carcinoma in China
Provisionally accepted
- 1Department of Pharmacy, Guangdong Women and Children Hospital, Guangzhou, China
- 2Jinan University College of Pharmacy, Guangzhou, China
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Introduction: While the APOLLO trial confirmed the clinical efficacy of first-line anlotinib plus penpulimab in unresectable hepatocellular carcinoma (HCC), its economic impact on China's healthcare system remains underexplored. This study was conducted to evaluate the cost-effectiveness of this novel combination versus sorafenib from the perspective of the Chinese healthcare system. Methods: A partitioned survival model with three health states was developed to simulate economic outcomes for advanced HCC patients. Survival data were derived from the APOLLO trial using parametric fitting. Direct medical costs and utility values were obtained from local public databases and published literature. Primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) evaluated against the willingness-to-pay (WTP) threshold of $40,334.05/QALY. Model robustness was assessed through deterministic and probabilistic sensitivity analyses (PSA). Results: The base-case analysis showed that anlotinib plus penpulimab incurred a total cost of $25,681.69 and yielded 1.42 QALYs, compared with sorafenib's total cost of $18,082.48 and 1.19 QALYs. This resulted in an incremental cost of $7,599.21 and an incremental effectiveness of 0.22 QALYs, resulting in an ICER of $34,050.28/QALY, which is below the predefined WTP threshold. Sensitivity analyses identified anlotinib treatment duration (cycles) and progression-free survival (PFS) utility values as key drivers of model variability. The PSA indicated an 85.9% probability of cost-effectiveness at the WTP threshold. Conclusions: Anlotinib plus penpulimab represents a potentially cost-effective first-line treatment for advanced HCC from the Chinese healthcare system perspective. These findings support incorporating this regimen into guidelines for selecting cost-effective immunotherapeutic strategies and provide evidence to inform decision-making in resource allocation for advanced HCC management.
Keywords: cost-effectiveness analysis, partitioned survival model, Anlotinib, Penpulimab, Sorafenib, Unresectable hepatocellular carcinoma
Received: 23 May 2025; Accepted: 09 Oct 2025.
Copyright: © 2025 Fang, Liang, Wang, Sheng and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jun Xu, xujun@jnu.edu.cn
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