Cost-effectiveness analysis of durvalumab combined with tremelimumab versus sorafenib as first-line treatment for unresectable Hepatocellular carcinoma in China: a dual-model approach utilizing partitioned survival and markov models.

Authors

Ruixuan Liu, Yong Xiao, Zhen Wang, Qing Yang

Published in

BMC gastroenterology. Volume 26. Issue 1. Sep 07, 2026. Epub Sep 07, 2026.

Abstract

Hepatocellular carcinoma (HCC) is a major contributor to global cancer-related mortality, with the majority of patients diagnosed at unresectable stages. The STRIDE regimen (tremelimumab plus durvalumab) demonstrated superior survival benefits over sorafenib in the HIMALAYA trial. However, its cost-effectiveness within the Chinese healthcare system remains unverified.
To evaluate the cost-effectiveness of first-line STRIDE versus sorafenib for unresectable HCC from the perspective of the Chinese healthcare payer.
A comprehensive cost-effectiveness analysis was conducted using both partitioned survival (PartSA) and Markov state-transition models over a 10-year time horizon. Clinical efficacy parameters were derived from reconstructed HIMALAYA trial survival data. Direct medical costs were estimated based on post-negotiation drug pricing in China and published sources. Health utility weights were sourced from established literature. Scenario analyses (50% price reduction, 0% discount rate) and comprehensive deterministic and probabilistic sensitivity analyses (PSA) were performed to evaluate model uncertainty.
In the base-case analysis, the STRIDE regimen yielded incremental cost-effectiveness ratios (ICERs) of $204,713.55/QALY in the PartSA model and $208,385.86/QALY in the Markov model, both substantially exceeding China's willingness-to-pay threshold (3× GDP per capita, $36,975/QALY). Under a 50% price reduction scenario, the ICER dropped to $87,351.95/QALY but remained non-cost-effective. Probabilistic sensitivity analysis demonstrated a < 20% likelihood of STRIDE being cost-effective across tested scenarios. Key cost drivers included drug acquisition costs and progression-free utility values.
Under current pricing, the STRIDE regimen is not cost-effective as a first-line treatment for unresectable HCC in China. While price concessions improve affordability, exploration of value-based pricing and future biomarker-guided patient stratification could be evaluated to optimize economic viability. The dual-model concordance reinforces the robustness of these findings.

PMID:
42855671
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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