OBJECTIVES : Hepatic arterial infusion (HAI) of oxaliplatin, fluorouraciland leucovorin (FOLFOX) plus sorafenib has shown promising resultsversus sorafenib for hepatocellular carcinoma (HCC) patients with portalvein invasion. However, considering the high cost of hepatic arterialinfusion of chemotherapy (HAIC), this study evaluated the cost-effectiveness of HAIC plus sorafenib versus standard care for HCCpatients from the perspective of the medical system in China.

METHODS : A Markov model was constructed to simulate the diseasecourse and source consumption of HAIC plus sorafenib (SoraHAIC).Costs of primary drug therapy, hepatic artery catheterization,hepatectomy and nursing expenses were collected from the Fujian PriceBureau, clinical data, the other costs and utility data were referencedfrom the published literature. Life-years (LYs), and quality-adjusted life-years (QALYs) were the main outcomes. Sensitivity analyses exploredthe uncertainty of model assumptions.

RESULTS : SoraHAIC gained 1.18 QALYs (1.68 LYs) at a cost of $65,254,while the effectiveness and cost of sorafenib were 0.52 QALYs (0.79 LYs)and $14,280, respectively. The ICER comparing the two regimens was$77,132/QALY saved ($57,153/LY). Parameters that most influenced theICER were utility of PFS state. The PSA showed that 0% of thesimulations were favorable to SoraHAIC at the WTP of 3*GDP of China($30,492/QALY), but if the 3*GDP of Beijing ($72,000/QALY) was usedas WTP, the acceptability of SoraHAIC was 38.8%.

CONCLUSIONS : The study results indicate that SoraHAIC is not cost-effective at a WTP threshold of $30,492/QALY representative across allof China. In developed areas of China (Beijing), there was a 38.8%probability that the SoraHAIC regimen would be cost-effective.