Systematic review of cost-effectiveness of Chinese PD-1/PD-L1 inhibitors as first-line treatment for hepatocellular carcinoma

This systematic review evaluates the economic evidence of Chinese PD-1/PD-L1 inhibitors as first-line therapy for hepatocellular carcinoma (HCC) in China. The primary objective is to summarize cost-effectiveness findings to compare economic outcomes across specific therapeutic regimens and guide policymakers in optimizing resource allocation for HCC treatment. We conducted a comprehensive search of PubMed, Embase, and Cochrane databases up to July 19, 2024, following PICO (Population, Intervention, Comparison, Outcomes) criteria for study selection. This review was not registered in PROSPERO as it is a narrative synthesis of economic evaluations rather than a protocol-driven meta-analysis. Nonetheless, we rigorously adhered to PRISMA guidelines to ensure methodological transparency and accuracy throughout the study selection and data extraction processes. Data from eligible studies were systematically extracted and analyzed. Fourteen cost-effectiveness analyses met inclusion criteria, and the interventions evaluated primarily compared immunotherapy with targeted therapy. Eleven studies (78.6%) demonstrated cost-effectiveness against their respective willingness-to-pay thresholds (all values reported in US dollars), with the majority favoring sintilimab-based regimens over other therapeutic options. Current evidence indicates that the sintilimab plus bevacizumab biosimilar regimen is likely cost-effective as a first-line treatment for patients with unresectable hepatocellular carcinoma. These findings support considerations for broader insurance coverage of this specific combination therapy within China’s volume-based procurement system. Future research should incorporate real-world data and enhance both the quantity and quality of economic evaluations to strengthen the evidence base.