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Therap Adv Gastroenterol. 2019 Sep 23;12:1756284819878304. doi: 10.1177/1756284819878304. eCollection 2019.

Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis.

Author information

1
Department of Medicine D and the Liver Institute, Rabin Medical Center, Beilinson hospital, 39 Jabotinsky street, Petach-Tikva, 49100, Israel.
2
Coller School of Management, Tel Aviv University, Tel Aviv, Israel.
3
Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach-Tikva, Israel.

Abstract

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.

KEYWORDS:

liver cancer; multi-kinase inhibitor; quality-adjusted life-years; willingness to pay

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

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