Cost-Effectiveness of Sorafenib, Lenvatinib, and FOLFOX4 for Advanced Hepatocellular Carcinoma in China

Objective: Liver cancer is the third leading cause of cancer mortality in China. This study assesses the cost-effectiveness of sorafenib, lenvatinib, and FOLFOX4 in the treatment of advanced hepatocellular carcinoma (HCC) to inform clinical decision-making.Material and Methods: We used a Markov model to simulate the progression of HCC and calculate Quality-Adjusted Life Years (QALYs) and Incremental Cost-Effectiveness Ratios (ICERs) under two scenarios. Costs were obtained from the Yaozhi Network, while transition probabilities and utilities were derived from the REFLECT, EACH, and CELESTIAL clinical trials. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to evaluate model robustness and parameter uncertainty.Results: In Scenario A, using market-listed prices, sorafenib, and lenvatinib were found to be more cost-effective than FOLFOX4, with ICERs of $11,635.28 and $1,499.93 per QALY, respectively, both below the cost-effectiveness threshold. In Scenario B, with centralized procurement prices, sorafenib had a negative ICER of -$7,351.26 per QALY, indicating cost savings with improved outcomes, while lenvatinib had an ICER of $2,685.99 per QALY. Sensitivity analysis revealed that drug costs, utilities of disease progression, and discount rates were key determinants of ICER values.Conclusion: Sorafenib and lenvatinib are significantly more cost-effective compared to FOLFOX4, particularly under centralized procurement pricing. These results support the inclusion of these treatments in public health policy to enhance healthcare outcomes and optimize resource allocation, thereby improving the economic and quality-of-life metrics for patients with HCC.