Cost-effectiveness analysis of anlotinib plus penpulimab as first-line treatment for unresectable hepatocellular carcinoma

BACKGROUND: The APOLLO trial showed anlotinib combined with penpulimab (AN-PE) was effective as first-line therapy for unresectable hepatocellular carcinoma (uHCC) versus sorafenib (SOR). Given high drug costs, this study evaluated the cost-effectiveness of AN-PE from the Chinese healthcare system perspective. METHOD: A partitioned survival model was built with TreeAge2022. Clinical data were derived from the APOLLO trial, drug costs from national procurement prices, and other parameters from literature. Outcomes included costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Model robustness was examined via one-way and probabilistic sensitivity analyses. RESULTS: AN-PE gained 1.38 QALYs at $51,584.30, while SOR gained 1.16 QALYs at $12,414.88. The ICER was $174,830.60/QALY. Key drivers were progression-free survival(PFS) utility, penpulimab cost, progressive disease(PD) utility and anlotinib cost. At a willingness to pay (WTP) threshold of $40,365/QALY, AN-PE had 0% cost-effectiveness probability. CONCLUSION: AN-PE is unlikely to be cost-effective as first-line uHCC treatment in China.