Atezolizumab and Bevacizumab Combination in Advanced Hepatocellular Carcinoma; A Systematic Review of Economic Evaluations

Abstract

Abstract Background: Atezolizumab (ATZ) plus bevacizumab (BVC) co-administration is one of the newest systemic interventions in advanced hepatocellular carcinoma (AHCC). This treatment approach is more costly and more effective than other therapeutic interventions, and significantly improved AHCC survival and health-related quality of life. Objectives: This economic study aimed to systematically review all cost-effectiveness analyses of ATZ/BVC combination in AHCC. Method: To find all related economic evaluations, a comprehensive search in scientific databases was performed by a highly sensitive syntax. The target population was AHCC patients. The intervention was ATZ/BVC which was compared with sorafenib, nivolumab, and other anticancer strategies. We included studies that reported quality-adjusted life-years (QALYs) and/or life-years, costs, and incremental cost-effectiveness ratio (ICER), and finally, the characteristics of included studies were categorized. Results: Out of 315 identified records, 12 cost-effectiveness analyses were eligible for inclusion in the systematic review. Treatment costs were significantly higher with ATZ/BVC in all studies (From 61,397 to 253,687 USD compared to sorafenib and nivolumab, respectively). Incremental QALYs varied from 0.35 to 0.86 compared to sintilimab/BVC and sorafenib, respectively. Although ICERs for drugs varied widely, all were united in the lack of cost-effectiveness of the ATZ/BVC. The willingness-to-pay threshold in all studies was lower than the ICER, which indicated a reluctance to pay for this treatment strategy by the health systems. Conclusion: It can be concluded that ATZ/BVC combination is an expensive approach in AHCC management. Significant discounts in ATZ and BVC prices are essential for this novel approach to be cost-effective and extensively used.