Cost-effectiveness of sorafenib treatment in field practice for patients with hepatocellular carcinoma

Hepatology. 2013 Mar;57(3):1046-54. doi: 10.1002/hep.26221. Epub 2013 Feb 12.


The purpose was to assess the cost-effectiveness of sorafenib in the treatment of hepatocellular carcinoma (HCC) patients incorporating current prices and the results of the recent published field practice SOraFenib Italian Assessment (SOFIA) study. We created a Markov Decision Model to evaluate, in a hypothetical cohort of Caucasian male patients, aged 67 years with Barcelona Clinic Liver Cancer (BCLC) C HCC, or BCLC B HCC who were unfit or failed to respond to locoregional therapies, well compensated cirrhosis, and with performance status 0-1 according to Eastern Cooperative Oncology Group (ECOG), the cost-effectiveness of the following strategies: (1) full or dose-adjusted sorafenib for BCLC B and C patients together; (2) full or dose-adjusted sorafenib for BCLC B patients; (3) full or dose-adjusted sorafenib for BCLC C patients. Outcomes include quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER). In the base-case analysis dose-adjusted sorafenib was the most effective of the evaluated strategies. For dose-adjusted sorafenib, QALY was 0.44 for BCLC B and C patients together, 0.44 for BCLC C patients, and 0.38 for BCLC B patients. The ICER of dose-adjusted sorafenib compared with BSC was €34,534 per QALY gained for BCLC B and C patients together, €27,916 per QALY gained for BCLC C patients, and €54,881 per QALY gained for BCLC B patients. Results were sensitive to BSC survival rate, and sorafenib treatment duration.

Conclusion: In daily practice dose-adjusted, but not full-dose, sorafenib is a cost-effective treatment compared to BSC in intermediate and advanced HCC.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Antineoplastic Agents / economics
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Hepatocellular / drug therapy*
  • Carcinoma, Hepatocellular / economics*
  • Carcinoma, Hepatocellular / mortality
  • Cost-Benefit Analysis
  • Drug Costs
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / drug therapy*
  • Liver Neoplasms / economics*
  • Liver Neoplasms / mortality
  • Male
  • Markov Chains
  • Multivariate Analysis
  • Niacinamide / analogs & derivatives*
  • Niacinamide / economics
  • Niacinamide / therapeutic use
  • Phenylurea Compounds / economics*
  • Phenylurea Compounds / therapeutic use*
  • Prospective Studies
  • Quality-Adjusted Life Years
  • Sorafenib


  • Antineoplastic Agents
  • Phenylurea Compounds
  • Niacinamide
  • Sorafenib