Abstract
BACKGROUND: Anlotinib plus penpulimab has been proven to have good efficacy and safety in the treatment of unresectable hepatocellular carcinoma (uHCC). This study aims to evaluate the cost-effectiveness of anlotinib plus penpulimab compared with sorafenib in the treatment of uHCC from the perspective of the Chinese health system. METHODS: Based on the APOLLO clinical trial, a Markov model was constructed, with a simulation time range of 10 years and a cycle of 3 weeks. Costs and quality-adjusted life years (QALYs) were used as model output indicators. The incremental cost-effectiveness ratio (ICER) was calculated through cost-effectiveness analysis, and a willingness-to-pay (WTP) threshold of $37,944.50 was set, which is three times the per capita GDP of China in 2023, to determine the economic feasibility of anlotinib plus penpulimab compared with sorafenib. Sensitivity analysis and scenario analysis were utilized to test the robustness of the model. RESULTS: The basic analysis results indicated that the anlotinib plus penpulimab group spent $11,191 more than the sorafenib group but gained 0.56 QALYs. The ICER was $19,983.93/QALY, which was lower than three times the per capita GDP of China. The scenario analysis and sensitivity analysis demonstrated the robustness of the model. In 99.9% of the simulations, the incremental cost of each QALY gained by the anlotinib plus penpulimab group was less than $37,944.50. CONCLUSION: Under the threshold of three times China's per capita GDP, anlotinib plus penpulimab is more cost-effective compared with sorafenib.