OBJECTIVES : Liver cancer is the most common cancer with limited treatment options for patients at advanced stage. Lenvatinib was proved to be non-inferior compared to the only targeted cancer drug sorafenib for the treatment of unresectable hepatocellular carcinoma (HCC) in the Phase III REFLECT trial. This study was to develop a cost-effectiveness model of lenvatinib for the first-line treatment of unresectable hepatocellular carcinoma (HCC) in China based on data from REFELECT trail.

METHODS : A partitioned survival model (PSM) was developed with the following health states: progression-free, progressed and dead. The time horizon of the model was life time with payer’s perspective in China. Efficacy and safety data were extracted from the REFLECT trial. Utility values were derived from the European Quality-of-Life 5-Dimension Questionnaire, conducted with patients enrolled in the REFLECT trial. Direct medical costs were obtained from 8 hospitals located in eastern, middle and western China. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS : The incremental cost-effectiveness ratio (ICER) for lenvatinib versus sorafenib was ¥ 633,212 per quality-adjusted life year (QALY) gained.

CONCLUSIONS : Lenvatinib is not expected to be a cost-effective use in healthcare system in China, assuming a cost-effectiveness threshold of 3 times per capita GDP per QALY, which is 216,600 RMB.