Cost-effectiveness analysis of atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma subgroup analyses

Lead Investigator: Yi-Wen Tsai, National Yang Ming Chiao Tung University
Title of Proposal Research: Cost-effectiveness analysis of atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma subgroup analyses
Vivli Data Request: 9129
Funding Source: None
Potential Conflicts of Interest: None

Summary of the Proposed Research:

Unresectable (cannot be removed by surgery) hepatocellular carcinoma (uHCC) is an advanced stage of hepatocellular carcinoma (HCC) in which tumors invade the portal veins, veins that are responsible for supplying oxygen and nutrients to liver and/or other organs. The 5-year survival rate is nearly 19% in HCC, but only 2% is advanced stage of HCC. Sorafenib is drug therapy that works by blocking the abnormal proteins that cause cancer cells to multiply. Although sorafenib has been the standard systemic therapy in uHCC since 2008, the 5-year survival rate for uHCC with sorafenib treatment increases variously across countries, 5% in China, 7.7% in Japan and 10% in Poland.
Two drugs called Atezolizumab (a checkpoint inhibitor that blocks proteins that stop the immune system from attacking cancer cells) and Bevacizumab (a targeted drug therapy that prevents the growth of tumor tissues) are also used in treating HCC. Recently, atezolizumab plus bevacizumab (Atezo-bev) combination treatment has been shown to extend survival and delay disease progression compared with sorafenib in uHCC patients. However, Atezo-bev was found not to be cost-effective compared with sorafenib from the US payer perspective. Quality-adjusted life years (QALYs) are used as a measure of a person’s quality of life – 1 QALY is equal to 1 year of life in perfect health.
Atezo-bez treatment combination has been found to increase patients QALYs to a greater extent than sorafenib, but the incremental cost-effective ratio (ICER) of Atezo-bez (calculated from the cost of the two treatments and the increase in QALYs) was too high for payers compared to sorafenib.

Our study intends to evaluate the cost-effectiveness of atezolizumab plus bevacizumab compared with sorafenib in subgroups of unresectable hepatocellular carcinoma. We will derive efficacy, utility and safety data from the IMbrave150 trial and collect cost of atezolizumab, bevacizumab, sorafenib, subsequent treatments in post-progression and management of severe adverse events from Taiwan National Health Insurance.

Requested Studies:

A Phase III, Open-Label, Randomized Study of Atezolizumab in Combination With Bevacizumab Compared With Sorafenib in Patients With Untreated Locally Advanced or Metastatic Hepatocellular Carcinoma
Data Contributor: Roche
Study ID: NCT03434379
Sponsor ID: YO40245

I will bring cost data in aggregated numbers such as the cost of AE management and subsequent treatments in post-progression. This aggregated cost data will be generated from National Health Insurance Research Database (NHIRD) in Taiwan.
Data Contributor: I WILL BRING MY OWN
Sponsor ID: Aggregated cost data