Cost-Effectiveness Analysis of Atezolizumab and Bevacizumab versus Sorafenib in the Treatment of Hepatocellular Carcinoma: A Systematic Review

Hepatocellular Carcinoma (HCC) is the most common type of liver cancer and can lead to multiple complications if left untreated. Disease incidence has increased and is expected to continue doing so in the coming years. However, treatment is expensive, which limits its application in poorer communities. Consequently, this study aimed to evaluate the costeffectiveness of the combination of atezolizumab and bevacizumab versus sorafenib in the treatment of HCC. We performed a systematic review of published economic evaluation studies investigating the cost-effectiveness of atezolizumab and bevacizumab versus sorafenib using the following databases: PubMed, NHS Economic Evaluation, Cochran, and Scopus. This study was conducted according to the PRISMA reporting guidelines. Three independent reviewers screened all relevant articles published before March 2022. The Cheers checklist was used to assess the quality of the selected studies, and all relevant outcomes were assessed. Six studies met the inclusion criteria. QALY ranged from 0.811 to 2.7 in the combination group, and from 0.84 to 1.021 in the sorafenib group. The incremental cost-effectiveness ratio varied from $104,242/LY to $250,907/LY and from $61,613/QALY to $322,500/QALY. We concluded that atezolizumab plus bevacizumab was no more costeffective than sorafenib, with the major contributing factor being the price of medication; thus, a reduction in price may improve cost-effectiveness. Further studies are needed that consider a greater variety of middle-to-low income populations in both clinical trial and practice.