Comparative pharmacoeconomic analysis of sequential treatment lines for advanced hepatocellular carcinoma: a real-world clinical practice study

Aim of the study was to conduct a pharmacoeconomic evaluation of different drug therapy regimens for hepatocellular carcinoma (HCC).
Material and Methods. This study assessed three treatment strategies for advanced HCC, involving the use of one, two, and three sequential lines of drug therapy. The analysis included the calculation of the Cost- Effectiveness Ratio (CER) and the Incremental Cost-Effectiveness Ratio (ICER). Furthermore, the ICER values were compared against a reference willingness-to-pay (WTP) threshold. The study included 53 patients with unresectable HCC, of whom 37, 13, and 3 received one, two, and three lines of drug therapy, respectively.
Results. The duration of the first, second, and third lines of therapy did not differ significantly. The cost of the first line of therapy was the lowest when compared to the second and third lines. The value of CER was minimal for one line of therapy and maximal for three lines. Overall survival differed significantly only between the groups receiving one and two lines of therapy. The median survival in the groups receiving 1, 2, and 3 lines of therapy was 1.25, 1.83 and 2.0 years, respectively; however, the differences between the 1- and 3-line groups, as well as between the 2- and 3-line groups, were statistically insignificant. The ICER was lowest when comparing one versus two lines of therapy and highest when comparing two versus three lines. In all cases, the ICER exceeded the adopted reference WTP threshold of 2,592,000 RUB/year.
Conclusions. Although strategies involving two and three lines of therapy are associated with a gain in survival, they are characterized by an incremental cost per additional year of life that substantially exceeds the reference WTP threshold. This indicates their limited cost-effectiveness within the adopted evaluation framework. The decision to use these strategies should be made on an individual basis, considering clinical prognostic factors and with an awareness of the substantial financial burden they impose on the healthcare system. These results can be used in funding allocation and drug therapy planning in HCC patients within the domestic healthcare system.

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