Dawood Zaiba Shafik, Brown Zachary J, Endo Yutaka, Katayama Erryk S, Munir Muhammad Musaab, Alaimo Laura, Ruff Samantha M, Lima Henrique A, Woldesenbet Selamawit, Pawlik Timothy M
Medical College, The Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
Department of Surgery, New York University Long Island School of Medicine, Mineola, NY, USA.
Surg Oncol. 2023 Oct 24;51:102013. doi: 10.1016/j.suronc.2023.102013.
Immune checkpoint inhibitors (ICIs) have recently been introduced into the treatment algorithm of patients with hepatocellular carcinoma (HCC). However, the cost effectiveness of ICIs compared with pre-existing therapies for HCC has not been assessed. We performed a meta-analysis to understand the incremental cost effectiveness of ICIs compared with sorafenib.
PubMed, Embase, Medline, Scopus, and CINAHL databases were searched (2000-2022). The incremental cost, incremental effectiveness, incremental cost effectiveness ratio (ICER) of ICI compared with sorafenib and willingness to pay (WTP) were extracted from each study. The variables were used to derive the incremental net benefit (INB). Random-effect meta-analysis was then conducted to derive the pooled INB of ICI compared with sorafenib.
Five studies (3265 patients, 82.1 % male) met inclusion criteria. All studies assessed the cost effectiveness of ICIs compared with sorafenib. Studies used Quality adjusted life years to assess incremental effectiveness and reported ICER values ranging from $21,000 to $221,000 for ICIs and sorafenib. Four out of five studies reported that ICI had a higher ICER compared with sorafenib at WTP $150,000. The overall pooled INB was US$-42,000 (95 % CIUS$-96,000, US$11,528) suggesting that ICI was not cost effective compared with sorafenib.
When compared with sorafenib, ICIs were not a cost-effective option for systemic therapy for patients with HCC. More work focusing on cost effective options for patients with HCC is warranted.
免疫检查点抑制剂（ICI）最近已被纳入肝细胞癌（HCC）患者的治疗方案。然而，与现有的HCC治疗方法相比，ICI的成本效益尚未得到评估。我们进行了一项荟萃分析，以了解ICI与索拉非尼相比的增量成本效益。
检索了PubMed、Embase、Medline、Scopus和CINAHL数据库（2000 - 2022年）。从每项研究中提取ICI与索拉非尼相比的增量成本、增量效果、增量成本效果比（ICER）和支付意愿（WTP）。这些变量用于得出增量净效益（INB）。然后进行随机效应荟萃分析，以得出ICI与索拉非尼相比的合并INB。
五项研究（3265例患者，82.1%为男性）符合纳入标准。所有研究都评估了ICI与索拉非尼相比的成本效益。研究使用质量调整生命年评估增量效果，并报告ICI和索拉非尼的ICER值在21,000美元至221,000美元之间。五项研究中有四项报告称，在支付意愿为150,000美元时，ICI与索拉非尼相比具有更高的ICER。总体合并INB为 - 42,000美元（95%置信区间为 - 96,000美元，11,528美元），这表明与索拉非尼相比，ICI不具有成本效益。
与索拉非尼相比，ICI不是HCC患者全身治疗的成本效益选择。有必要开展更多针对HCC患者成本效益选择的研究。
