Intravenous atezolizumab plus bevacizumab was not found to be cost-effective as a first-line treatment for patients with unresectable or metastatic hepatocellular carcinoma (HCC), compared with oral sorafenib. These findings were published in JAMA Network Open.
Researchers at Xi’an Jiaotong University in China simulated a patient population similar to that of the IMbrave150 phase 3 trial and projected 6-year treatment costs using financial data from the Centers for Medicare and Medicaid Services and from the Medicare physician fee schedule for 2020. Cost-effective thresholds were defined as $100,000-$150,000 per quality-adjusted life-years (QALY). Costs were adjusted to 2020 United States inflation rates.
The IMbrave150 trial compared intravenous infusions of 1200 mg atezolizumab plus 15 mg/kg of body weight bevacizumab every 3 weeks against 400 mg twice-daily oral sorafenib. While sorafenib therapy was found to increase survival from 6.5 to 14.7 months, the dual therapy is currently the only regimen proven more clinically effective in phase 3 trials.
On the basis of a hypothetical population of 424 patients with unresectable or metastatic HCC, atezolizumab plus bevacizumab was associated with an increase of 1.412 QALYs and sorafenib with 0.928 QALYs. The total drug and non-drug costs were $313,193 and $156,984 for atezolizumab plus bevacizumab and sorafenib, respectively.
These values corresponded with an incremental cost-effectiveness ratio (ICER) of $322,500 (5th-95th percental range, $149,364-$683,744) per QALY for atezolizumab plus bevacizumab compared with sorafenib.
In order for the dual therapy to be cost-effective, the price would need to be reduced by 37%-47%. With cut-offs of $100,000 and $150,000 per QALY, atezolizumab plus bevacizumab was only cost-effective in 0.6% and 5.1% of simulated scenarios (n=10,000), respectively.
This study was limited by the fact that the long-term efficacy of atezolizumab with bevacizumab has yet to be determined, which could alter the effectiveness of this model.
The study authors concluded that atezolizumab plus bevacizumab was not cost-effective when compared against sorafenib as a first-line therapy for patients with unresectable or metastatic HCC.
Zhang X, Wang J, Shi J, Jia X, Dang S, Wang W. Cost-effectiveness of atezolizumab plus bevacizumab vs sorafenib for patients with unresectable or metastatic hepatocellular carcinoma. JAMA Netw Open. 2021;4(4): e214846. doi: 10.1001/jamanetworkopen.2021.4846