Cost-effectiveness of toripalimab plus bevacizumab versus sorafenib as first-line treatment for advanced hepatocellular carcinoma in China and the United States healthcare systems

INTRODUCTION: Toripalimab combined with bevacizumab has demonstrated significant clinical efficacy and survival benefits in patients with advanced hepatocellular carcinoma (HCC). However, the high cost of this combination therapy raises concerns regarding its cost-effectiveness in healthcare systems in China and the U.S. AIM: This study evaluated the cost-effectiveness of toripalimab plus bevacizumab compared with sorafenib from the perspectives of the Chinese and U.S. healthcare systems. The findings are intended to inform value-based pricing strategies, reimbursement decisions, and clinical resource allocation. METHOD: A partitioned survival model (PSM) was developed to estimate incremental cost-effectiveness ratios (ICERs) from the healthcare system perspective. Willingness-to-pay (WTP) thresholds were set at $40,011 per quality-adjusted life year (QALY) in China and $100,000-$150,000 per QALY in the U.S. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model outcomes. RESULTS: In China, toripalimab plus bevacizumab produced an ICER of $55,764.00/QALY compared with sorafenib, exceeding the local WTP threshold of $40,011/QALY. In the U.S., the ICER was $460,054.17/QALY, which also exceeded the commonly accepted WTP thresholds. Sensitivity analyses indicated that the discount rate and the proportion of patients receiving subsequent anti-cancer therapies were the primary cost drivers in China and the United States, respectively. Probabilistic sensitivity analysis showed a 0.7% and 1.5% probability of cost-effectiveness at WTP thresholds of $100,000/QALY and $150,000/QALY in the U.S., respectively. In China, the probability of cost-effectiveness was 3.2% at a WTP threshold of $40,011/QALY. CONCLUSION: At current pricing levels, toripalimab plus bevacizumab is unlikely to be cost-effective compared with sorafenib in either China or the U.S. These findings highlight the need for value-based pricing strategies and more efficient allocation of healthcare resources.