Cost-effectiveness analysis of ramucirumab treatment for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations of at least 400 ng/ml. (2nd April 2020)

• Record Type: Journal Article
• Authors: Zheng, Hanrui; Qin, Zhou; Qiu, Xingjian; Zhan, Mei; Wen, Feng; Xu, Ting
• Is Part Of: Journal of medical economics. Volume 23:Number 4(2020)
• Page Start: 347
• Page End: 352
• Publication Date: 2020-04-02
• Subjects: Cost-effectiveness -- ramucirumab -- hepatocellular carcinoma -- United States -- quality-adjusted life year; I10 -- I10; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2019.1707211
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Objective: This study aimed to compare the cost-effectiveness of ramucirumab versus placebo for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations (AFP) of at least 400 ng/ml in the United States. Methods: A Markov model was constructed to assess the cost-effectiveness of ramucirumab. Health outcomes were measured as quality-adjusted life years (QALYs). With TreeAge software, the disease process was modeled as three health states: progression-free survival (PFS), progressive disease (PD), and death. Costs were extracted from the REACH-2 trial, and utility was derived from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare ramucirumab with placebo. Probabilistic sensitivity analyses were developed to examine the robustness of the results. Results: In the base case analysis, ramucirumab therapy had a cost of $55, 508.41 and generated 0.54 QALYs, while placebo therapy had a cost of $761.09 and generated 0.47 QALYs, leading to an additional $54, 747.32 in costs and 0.07 QALYs. The ICER was $782, 104.57 per QALY, which was much higher than the willingness-to-pay threshold of $100, 000 per QALY. According to sensitivity analyses, the utility of PD in the two groups was the dominant parameter influencing the ICER. Conclusion: Although ramucirumab was associated with prolonged survival for patients with advanced hepatocellular carcinoma who progressed on sorafenib treatment with an AFP of at least 400 ng/ml, it is not a cost-effective treatment from a United States payer perspective.