Cost-utility analysis of lenvatinib and sorafenib for the first-line treatment of unresectable hepatocellular carcinoma in Vietnam: Evidence from a lower-middle income country

Objectives: To evaluate cost-effectiveness of lenvatinib compared with sorafenib as first-line treatment in unresectable hepatocellular carcinoma (HCC) patients in Vietnam from a perspective of the public third-party payer. Methods: A three-health state partitioned survival model was developed to compare costs and health outcomes of lenvatinib and sorafenib in unresectable advanced HCC patients over a 10-year time horizon, using a cycle length of 28-day. Clinical data on efficacy and safety of lenvatinib and sorafenib from the REFLECT trial was used to extrapolate outcomes beyond the follow-up period, while medication costs and health care resources were estimated based on local data and clinical experts’ consultations. A discount rate of 3% was applied to both costs and outcomes. Parameter uncertainty was explored using one-way sensitivity analysis and probabilistic sensitivity analysis. The impact of different time horizons and different approaches to extrapolate survival time were examined in scenario analyses. Results: In unresectable HCC patients, lenvatinib gained more 0.28 life-years (LYs) equaling to 0.21 quality-adjusted life-years (QALYs) compared with sorafenib. Without consideration of reimbursement rate for all medications and co-insurance, usage of lenvatinib led to an increase of 3,451.3 USD. Therefore, lenvatinib was not cost-effective compared with sorafenib, with an incremental cost-effectiveness ratio (ICER) of 16,114.5 USD/QALY. However, if lenvatinib was reimbursed at the same rate as sorafenib (50%), it became cost-effective, with an ICER of 8,307.6 USD/QALY. Results from the base-case analysis were robust in different sensitivity analyses. Conclusions: With a significant improvement in progression-free survival, lenvatinib gained more LYs and QALYs compared with sorafenib. At the same reimbursement rate of sorafenib of 50%, lenvatinib was cost-effective from the perspective of the third-party payer.