Immune checkpoint inhibitors (ICIs) have been heralded as a breakthrough for treating advanced hepatocellular carcinoma (HCC); however, their inclusion in national medical insurance programs remains inconsistent. A detailed systematic review offers crucial insights into the economic viability of these treatments. The findings indicate a significant gap between the clinical benefits and the financial feasibility, raising important questions for stakeholders in healthcare policy and market access.
Study Overview and Methodology
Since 2017, ICIs have emerged as a pivotal treatment option for advanced HCC and unresectable HCC. Despite this, their adoption into national medical insurance programs is limited. The systematic review, registered under PROSPERO 2023: CRD42023417391, aimed to critically evaluate economic studies on ICIs for advanced HCC. Researchers utilized databases such as Scopus, Web of Science, PubMed, Embase, and Cochrane Central to gather relevant studies. Out of 898 identified records, only 17 met the inclusion criteria, reflecting a stringent selection process to ensure the relevance and quality of data.
Key Findings and Implications
The review highlighted several ICIs, including atezolizumab combined with bevacizumab, sintilimab with bevacizumab/bevacizumab biosimilar, nivolumab, camrelizumab with rivoceranib, pembrolizumab combined with lenvatinib, tislelizumab, durvalumab, and cabozantinib with atezolizumab. The economic evaluations indicated that these treatments are generally not cost-effective compared to tyrosine kinase inhibitors or other ICIs. The critical factors influencing cost-effectiveness were the price of anticancer drugs, hazard ratios for progression-free survival and overall survival, and utility values for health states.
Market access considerations underscore the importance of evaluating the affordability and sustainability of introducing new therapies like ICIs into public health systems. Decision-makers must weigh the clinical benefits against the economic burden posed by these high-cost treatments. This review serves as a pivotal reference for policymakers contemplating the inclusion of ICIs in national insurance schemes.
Concrete Inferences
Insights for Stakeholders
- High drug prices significantly hinder the cost-effectiveness of ICIs.
- Clinical benefits, such as improved survival rates, must be balanced with economic feasibility.
- Health utility values play a crucial role in determining the overall value of ICIs.
- Policymakers need robust economic evidence to make informed decisions on market access.
The review concludes that while ICIs can substantially prolong the lives of patients with advanced HCC, their high costs pose a significant barrier to widespread adoption. Decision-makers are urged to consider both economic evaluations and affordability before integrating these therapies into national healthcare programs.
Original Article:
Health Econ Rev. 2024 Jul 5;14(1):48. doi: 10.1186/s13561-024-00526-2.
ABSTRACT
Since 2017, immune checkpoint inhibitors (ICIs) have been available for the treatment of advanced hepatocellular carcinoma (HCC) or unresectable HCC, but their adoption into national medical insurance programs is still limited. Cost-effectiveness evidence can help to inform treatment decisions. This systematic review aimed to provide a critical summary of economic evaluations of ICIs as a treatment for advanced HCC and identify key drivers (PROSPERO 2023: CRD42023417391). The databases used included Scopus, Web of Science, PubMed, Embase, and Cochrane Central. Economic evaluations of ICIs for the treatment of advanced HCC were included. Studies were screened by two people. Of the 898 records identified, 17 articles were included. The current evidence showed that ICIs, including atezolizumab plus bevacizumab, sintilimab plus bevacizumab/bevacizumab biosimilar, nivolumab, camrelizumab plus rivoceranib, pembrolizumab plus lenvatinib, tislelizumab, durvalumab, and cabozantinib plus atezolizumab, are probably not cost-effective in comparison with tyrosine kinase inhibitors or other ICIs. The most influential parameters were price of anticancer drugs, hazard ratios for progression-free survival and overall survival, and utility for health statest. Our review demonstrated that ICIs were not a cost-effective intervention in advanced HCC. Although ICIs can significantly enhance the survival of patients with advanced HCC, decision-makers should consider the findings of economic evaluations and affordability before adoption of new therapies.
PMID:38967718 | DOI:10.1186/s13561-024-00526-2
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