Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis
Background and aims: The multi-kinase inhibitor sorafenib is a first-line drug for patients with advanced hepatocellular carcinoma (HCC). Treatment options for patients whose disease has progressed on sorafenib are limited. In a recent randomized controlled trial (CELESTIAL trial), patients with adv...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-09-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/1756284819878304 |
| _version_ | 1818316981996093440 |
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| author | Amir Shlomai Moshe Leshno Daniel A. Goldstein |
| author_facet | Amir Shlomai Moshe Leshno Daniel A. Goldstein |
| author_sort | Amir Shlomai |
| collection | DOAJ |
| description | Background and aims: The multi-kinase inhibitor sorafenib is a first-line drug for patients with advanced hepatocellular carcinoma (HCC). Treatment options for patients whose disease has progressed on sorafenib are limited. In a recent randomized controlled trial (CELESTIAL trial), patients with advanced HCC who had failed prior systemic therapy had moderate progression-free survival and overall survival advantages when treated with the multi-kinase inhibitor cabozantinib. However, since this treatment is costly and is accompanied by significant adverse events in a large proportion of patients, its cost-effectiveness in these patients should be determined. Methods: We developed a Markov model incorporating health outcomes, measured by life-years and quality-adjusted life-years (QALYs) to evaluate the cost-effectiveness of cabozantinib compared with placebo in patients who have failed prior systemic therapy. Results: Treatment with cabozantinib results in a mean gain of 11.6 weeks of life (0.22 life-years) as compared with placebo. When quality of life was incorporated, treatment with cabozantinib produced a gain of 0.16 QALYs. The total mean incremental cost of cabozantinib was US$76,406 per patient. The incremental cost-effectiveness ratio for cabozantinib compared with best supportive care was US$469,374/QALY using the recommended dose of 60 mg cabozantinib daily. Conclusion: Our results suggest that the use of cabozantinib in patients with advanced HCC who have progressed on prior treatment, results in a modest incremental benefit with high incremental costs, suggesting that it is not cost-effective at conventional willingness to pay thresholds. |
| first_indexed | 2024-12-13T09:30:04Z |
| format | Article |
| id | doaj.art-3375dcf1ff334825a476f2ca161af60b |
| institution | Directory Open Access Journal |
| issn | 1756-2848 |
| language | English |
| last_indexed | 2024-12-13T09:30:04Z |
| publishDate | 2019-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-3375dcf1ff334825a476f2ca161af60b2022-12-21T23:52:31ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482019-09-011210.1177/1756284819878304Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysisAmir ShlomaiMoshe LeshnoDaniel A. GoldsteinBackground and aims: The multi-kinase inhibitor sorafenib is a first-line drug for patients with advanced hepatocellular carcinoma (HCC). Treatment options for patients whose disease has progressed on sorafenib are limited. In a recent randomized controlled trial (CELESTIAL trial), patients with advanced HCC who had failed prior systemic therapy had moderate progression-free survival and overall survival advantages when treated with the multi-kinase inhibitor cabozantinib. However, since this treatment is costly and is accompanied by significant adverse events in a large proportion of patients, its cost-effectiveness in these patients should be determined. Methods: We developed a Markov model incorporating health outcomes, measured by life-years and quality-adjusted life-years (QALYs) to evaluate the cost-effectiveness of cabozantinib compared with placebo in patients who have failed prior systemic therapy. Results: Treatment with cabozantinib results in a mean gain of 11.6 weeks of life (0.22 life-years) as compared with placebo. When quality of life was incorporated, treatment with cabozantinib produced a gain of 0.16 QALYs. The total mean incremental cost of cabozantinib was US$76,406 per patient. The incremental cost-effectiveness ratio for cabozantinib compared with best supportive care was US$469,374/QALY using the recommended dose of 60 mg cabozantinib daily. Conclusion: Our results suggest that the use of cabozantinib in patients with advanced HCC who have progressed on prior treatment, results in a modest incremental benefit with high incremental costs, suggesting that it is not cost-effective at conventional willingness to pay thresholds.https://doi.org/10.1177/1756284819878304 |
| spellingShingle | Amir Shlomai Moshe Leshno Daniel A. Goldstein Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis Therapeutic Advances in Gastroenterology |
| title | Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis |
| title_full | Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis |
| title_fullStr | Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis |
| title_full_unstemmed | Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis |
| title_short | Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis |
| title_sort | cabozantinib for patients with advanced hepatocellular carcinoma a cost effectiveness analysis |
| url | https://doi.org/10.1177/1756284819878304 |
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