Cost-effectiveness analysis of atezolizumab plus bevacizumab compared with sorafenib as first-line treatment in advanced hepatocellular carcinoma in Singapore

ABSTRACT

Objectives

This study aims to explore the cost-effectiveness of atezolizumab plus bevacizumab against sorafenib for first-line treatment of locally advanced or metastatic hepatocellular carcinoma (HCC) in Singapore.

Methods

A partitioned survival model was developed from a healthcare system perspective, with a 10-year lifetime horizon. Clinical inputs and utilities were obtained from the IMbrave150 trial. Healthcare resource use costs were obtained from published local sources; drug costs reflected the most recent public hospital selling prices. Outcomes included life years, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to assess the model’s robustness.

Results

Atezolizumab plus bevacizumab offered an additional 1.42 life years and 1.09 QALYs, with an additional cost of S$111,847; the ICER was S$102,988/QALY. The World Health Organization considers interventions with ICERs <1 gross domestic product (GDP)/capita to be highly cost-effective. At a willingness-to-pay (WTP) threshold of S$114,165/QALY (Singapore’s 2022 GDP/capita), atezolizumab plus bevacizumab is cost-effective compared with sorafenib. The ICER was most sensitive to variations in utilities, but all parameter variations had no significant impact on the model outcomes.

Conclusion

At a WTP threshold of Singapore’s GDP/capita, atezolizumab plus bevacizumab is cost-effective compared with sorafenib.

KEYWORDS:

• Atezolizumab
• bevacizumab
• cost-effectiveness
• hepatocellular carcinoma
• programmed death ligand-1
• sorafenib

Article highlights

• The aim of this analysis was to assess the cost-effectiveness of atezolizumab plus bevacizumab compared with sorafenib as first-line treatment in advanced hepatocellular carcinoma (HCC) in Singapore.

• A partitioned survival model was developed using clinical data from the IMbrave150 trial, from the Singapore healthcare system perspective over a lifetime horizon of 10 years.

• Compared with sorafenib, atezolizumab plus bevacizumab led to gains in life years and quality-adjusted life years (QALY), at an incremental cost. The incremental cost-effectiveness ratio of atezolizumab plus bevacizumab compared with sorafenib is S$102,988/QALY.

• At a willingness-to-pay threshold of S$114,165/QALY, reflecting Singapore’s gross domestic product per capita in 2022, atezolizumab plus bevacizumab is cost-effective compared to sorafenib.

• Additional economic analyses should be conducted from a societal perspective to understand the wider societal value of atezolizumab plus bevacizumab, including its impact on reducing the burden associated with productivity losses in patients with advanced HCC and their caregivers.

Declaration of interest

C E Chee provided consulting/advisory services to AstraZeneca, GuardantHealth AMEA, Merck, and Roche Genentech, and received honoraria fees from Amgen, AstraZeneca, Merck Sharp & Dohme, PierreFabre, and Roche Genentech.

J S Khara, J Cheong, J Fong, and S Sivanesan are stock shareholders of Roche Singapore Pte Ltd, and are employed by Roche Singapore Pte Ltd.

J Y Choy, M Hu, and A Viswambaram provided consulting/advisory services to Roche Singapore Pte Ltd throughout the course of the study and manuscript development.

H C Toh received honoraria fees from Roche/Genentech, provided consulting/advisory services to Biosceptre International, and was part of a Speakers’ Bureau for AstraZeneca, Eisai, and Merck Sharp & Dohme.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Author contributions

All authors were involved in the conception and design, or analysis and interpretation of the data; the drafting of the paper or revising it critically for intellectual content; and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was funded by Roche Singapore Pte Ltd.