Cost-effectiveness analysis of anlotinib plus penpulimab versus sorafenib in the treatment of unresectable hepatocellular carcinoma

The APOLLO trial demonstrated that anlotinib plus penpulimab significantly prolonged progression-free survival (PFS) and overall survival compared to sorafenib in patients with unresectable hepatocellular carcinoma (HCC). However, its cost-effectiveness remains uncertain. This study aimed to evaluate the cost-effectiveness of this regimen from the perspective of the Chinese healthcare system. We constructed a partitioned survival model comprising three health states to evaluate the cost-effectiveness of anlotinib plus penpulimab versus sorafenib for unresectable HCC. Over a 10-y time horizon, we compared the total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) between two groups. The robustness of the results was validated through one-way sensitivity analysis and probabilistic sensitivity analysis (PSA). Compared to sorafenib, anlotinib plus penpulimab provided an additional 0.21 QALYs at an incremental cost of $18,194.86. This resulted in an ICER of $86,546.80/QALY. One-way sensitivity analysis revealed that the utility value for PFS exerted the greatest influence on the model results, followed by penpulimab prices and the disutility due to adverse events (grade ≥3) in the anlotinib plus penpulimab group. PSA indicated a 0% probability of the anlotinib plus penpulimab regimen being cost-effective at a willingness-to-pay threshold of $40,335/QALY. Scenario analysis results showed that the Patient Assistance Program of penpulimab could help the regimen achieve favorable cost-effectiveness. Compared with sorafenib, anlotinib plus penpulimab for unresectable HCC patients was unlikely cost-effective under the perspective of the Chinese healthcare system.