Cost-Effectiveness Analysis of Sorafenib in Treatment of Advanced Hepatocellular Carcinoma in Iran

Introduction: This study aimed to develop an economic model based on the perspectives of Iranian health systems in order to evaluate the cost-effectiveness of Sorafenib versus Best Supportive Care as the treatment of advanced hepatocellular carcinoma. Methods: AMarkov model, simulate the lifetime patient outcomes and coat of patients received Sorafenib or BSC treatment from Iranian health system perspective. The measure for efficacy was reported as Quality Adjusted Life Year (QALY) estimated by clinical success rates, overall survival, andutility scores retrieved from literature; the costs were retrieved from literature, clinicians’ routine practice, and Iran tariff book. Cost-effectiveness ratios (ICER) was estimated and sensitivity analysis was done to show the robustness of the model through variation of all probabilities andcosts Result: The total discounted QALYs in base scenario were higher with Sorafenib (0.710) than BSC (0.550). Moreover, the discounted costs per patient in Sorafenib group were higher (906,579,334 IRR) than in BSC groups (138,531,954IRR). Thus, the incremental cost-effectiveratio was IRR 4,779,255,511/QALY for sorafenib versus best supportive care. The result of oneway sensitivity analysis shows the prices of medicines are the most important variables which affects the result. Conclusion: On the basis of accepted willingness-to-pay in Iran(IRR148.000.000 /QALY), sorafenib is not a cost-effective option for treatment of patients with advanced HCC comparing best supportive care. As the significant cost reduction which is needed for being cost effectiveness may not be feasible for producer, a managed entry agreement wouldbe the best recommendation for sorafenib market access in Iran.

Keywords:

Sorafenib , Best Supportive Care , Hepatocellular carcinoma , Cost-effectiveness ,