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- Title
Cost-effectiveness analysis of lenvatinib treatment for patients with unresectable hepatocellular carcinoma (uHCC) compared with sorafenib in Japan.
- Authors
Kobayashi, Masahiro; Kudo, Masatoshi; Izumi, Namiki; Kaneko, Shuichi; Azuma, Mie; Copher, Ronda; Meier, Genevieve; Pan, Janice; Ishii, Mika; Ikeda, Shunya
- Abstract
<bold>Background: </bold>Lenvatinib demonstrated a treatment effect on overall survival by the statistical confirmation of non-inferiority to sorafenib for the first-line treatment of uHCC. The objective of this study was to evaluate the cost-effectiveness of lenvatinib compared with sorafenib for patients with uHCC in Japan.<bold>Methods: </bold>A partitioned-survival model was developed to estimate the cost-effectiveness of lenvatinib versus sorafenib when treating uHCC patients over a lifetime horizon and considering total public healthcare expenditure. Efficacy and safety data were extracted from the REFLECT trial. Utility values were derived from the European Quality-of-Life 5-Dimension Questionnaire, conducted with patients enrolled in the REFLECT trial. Direct medical costs, such as primary drug therapy, outpatient visits, diagnostic tests, hospitalization, post-progression therapy, and adverse-event treatments, were included. Cost parameters unavailable in the clinical trial or publications were obtained based on the consolidated clinical standards from a Delphi panel of four Japanese medical experts.<bold>Results: </bold>For lenvatinib versus sorafenib, the incremental cost was - 406,307 Japanese Yen (JPY), and the incremental life years and quality-adjusted life years (QALYs) were 0.27 and 0.23, respectively. Thus, lenvatinib dominated sorafenib, due to the mean incremental cost-effectiveness ratio falling in the fourth quadrant, conferring more benefit at lower costs compared with sorafenib. The probabilistic sensitivity analysis showed that 81.3% of the simulations were favorable to lenvatinib compared with sorafenib, with a payer's willingness-to-pay-per-QALY of 5 million JPY.<bold>Conclusions: </bold>Lenvatinib was cost-effective compared with sorafenib for the first-line treatment of uHCC in Japan.
- Subjects
JAPAN; DELPHI (Extinct city); HEPATOCELLULAR carcinoma; THERAPEUTICS; QUALITY-adjusted life years; JAPANESE yen; MEDICAL care costs
- Publication
Journal of Gastroenterology, 2019, Vol 54, Issue 6, p558
- ISSN
0944-1174
- Publication type
journal article
- DOI
10.1007/s00535-019-01554-0