Evaluating the cost-effectiveness of atezolizumab-bevacizumab in advanced hepatocellular carcinoma: Insights from Taiwan

Tsung-Wei Chang^a,b, Wei-Chiao Chang^b,c,d, Wan-Hsuan Chou^b, Wei-Pin Chang^e,g,h*, Chun-Nan Kuo^b,f**

^a Department of Pharmacy, Yuanlin Christian Hospital, Changhua, Taiwan

^b School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan

^c Master Program for Clinical Genomics and Proteomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan

^d Integrative Research Center for Critical Care, Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

^e School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan

^f Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

^g Research Center of Data Science on Health Care Industry, College of Management, Taipei Medical University, Taipei, Taiwan

^h Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan

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). Oneway 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.