Cost-utility analysis of Lenvatinib vs. Sorafenib in unresectable hepatocellular carcinoma in Iran

Hepatocellular carcinoma (HCC) is a global health issue and the third leading cause of cancer-related deaths. For patients with unresectable HCC (uHCC), Sorafenib and Lenvatinib, are key treatments. This study evaluates the cost-effectiveness of Lenvatinib versus Sorafenib for uHCC in Iran. A model-based cost-utility analysis was conducted using a Partitioned Survival Analysis (PartSA) model from the perspective of the Iranian society. Clinical data were sourced from the REFLECT trial, while cost inputs, including treatment, monitoring, and side-effect management, were derived from local healthcare data and expert consultations. Sensitivity analyses and Monte Carlo simulations ensured robustness. The base-case analysis revealed that Lenvatinib, with a total cost of $9,607, offers a cost saving of $1,551 compared to Sorafenib ($11,158). Lenvatinib also provides an incremental gain of 0.14 Quality-Adjusted Life Years (QALYs) per patient over a 20-years. Probabilistic sensitivity analysis showed a > 99% probability of Lenvatinib being cost-effective. One-way analysis confirmed Lenvatinib’s cost-effectiveness if priced below $18/day. Lenvatinib is a cost-effective alternative to Sorafenib for uHCC treatment in Iran, providing better clinical outcomes and cost savings. These results support its adoption as the preferred treatment, emphasizing the importance of integrating cost-effectiveness analyses into healthcare decision-making.