Chang Tsung-Wei, Chang Wei-Chiao, Chou Wan-Hsuan, Chang Wei-Pin, Kuo Chun-Nan
Department of Pharmacy, Yuanlin Christian Hospital, Changhua, Taiwan.
School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
J Food Drug Anal. 2025 Jun 13;33(2):163-171. doi: 10.38212/2224-6614.3542.
Following the observed significant improvements in overall survival and progression-free survival in clinical trials, the combination of atezolizumab and bevacizumab has been recommended as a first-line therapy for patients with unresectable hepatocellular carcinoma. Despite its clinical benefits, the high cost associated with this treatment poses a substantial challenge in routine practice in Taiwan. This study aims to assess the cost-effectiveness of atezolizumab plus bevacizumab in comparison to sorafenib monotherapy. This study utilized partitioned survival analysis and extrapolated survival over a 20-year horizon to conduct a cost-effectiveness analysis from the perspective of the National Health Insurance Administration. Efficacy and utility data were directly extracted from the IMbrave150 trial, with input parameters adjusted to align with clinical practice in Taiwan. One-way deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the results. Additionally, a scenario analysis was conducted to evaluate the impact of bevacizumab use on the outcomes. Compared to sorafenib, the combination of atezolizumab and bevacizumab resulted in an increase of 0.53 quality-adjusted life years (QALYs) and had an incremental cost of NT$1,867,151. The incremental cost-effectiveness ratio (ICER) was NT$3,523,768 per QALY, exceeding the commonly accepted willingness-to-pay threshold at NT$2,788,290 (three times Taiwan's gross domestic product per capita). One-way sensitivity analysis indicated that reducing the cost of atezolizumab plus bevacizumab to 70% would yield an ICER of NT$1,793,703. Scenario analysis demonstrated cost reduction in bevacizumab, either through the adoption of a biosimilar product or lower dosage, would make the combination cost-effective. Under Taiwan's National Health Insurance (NHI) system and based on the cost-effectiveness analysis in 2021, the combination of atezolizumab and bevacizumab is not cost-effective compared to sorafenib monotherapy for the treatment of unresectable hepatocellular carcinoma.
在临床试验中观察到总体生存期和无进展生存期有显著改善后，阿替利珠单抗和贝伐单抗的联合用药已被推荐作为不可切除肝细胞癌患者的一线治疗方案。尽管有临床益处，但这种治疗的高昂成本给台湾的常规医疗实践带来了巨大挑战。本研究旨在评估阿替利珠单抗联合贝伐单抗与索拉非尼单药治疗相比的成本效益。本研究采用分区生存分析并外推20年的生存期，从国民健康保险署的角度进行成本效益分析。疗效和效用数据直接取自IMbrave150试验，并对输入参数进行调整以符合台湾的临床实践。进行了单向确定性和概率敏感性分析以评估结果的稳健性。此外，还进行了情景分析以评估使用贝伐单抗对结果的影响。与索拉非尼相比，阿替利珠单抗和贝伐单抗的联合用药使质量调整生命年（QALY）增加了0.53，增量成本为新台币1,867,151元。增量成本效益比（ICER）为每QALY新台币3,523,768元，超过了普遍接受的支付意愿阈值新台币2,788,290元（台湾人均国内生产总值的三倍）。单向敏感性分析表明，将阿替利珠单抗联合贝伐单抗的成本降低至70%将产生ICER为新台币1,793,703元。情景分析表明，通过采用生物类似药产品或降低剂量来降低贝伐单抗的成本，将使联合用药具有成本效益。在台湾的国民健康保险（NHI）系统下，基于2021年的成本效益分析，阿替利珠单抗和贝伐单抗联合用药与索拉非尼单药治疗不可切除肝细胞癌相比不具有成本效益。
Cancers (Basel). 2021-1-11
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