Author/Authors :
Meyers, Brandon M Department of Oncology - Juravinski Hospital and Cancer Centre - Hamilton Health Sciences - McMaster University, Canada , Vogel, Arndt Department of Gastroenterology - Hepatology and Endocrinology - Medical School Hannover, Germany , Marotta, Paul Multi-Organ Transplant Program - London Health Sciences Center - the University of Western Ontario, London, Canada , Kavan, Petr Department of Oncology - Faculty of Medicine - McGill University, Montreal, Canada , Kamboj, Laveena Eisai Ltd - Mississauga, Ontario, Canada , Pan, Janice Eisai Inc. - Woodcliff Lake, USA , Geadah, Marc PIVINA Consulting Inc - Mississauga, Ontario, Canada , Trueman, David Source Health Economics, London, UK , Sabapathy, Suthakar Eisai Ltd - Mississauga, Ontario, Canada
Abstract :
Lenvatinib is an oral multikinase inhibitor indicated for the first-line treatment of unresectable hepatocellular carcinoma (uHCC). In the Phase III REFLECT trial, lenvatinib was noninferior in the primary endpoint of overall survival versus sorafenib, the only systemic therapy funded in Canada prior to the introduction of lenvatinib. Lenvatinib also demonstrated statistically significant improvement compared to sorafenib in secondary endpoint progression-free survival, time to progression, and objective response rate. The aim of this analysis was to estimate the cost-effectiveness of lenvatinib versus sorafenib for the first-line treatment of patients with uHCC from a Canadian perspective. A cost-utility analysis was conducted using partitioned survival modelling, with health states representing progression-free disease, progressed disease, and death. Health effects were measured using quality-adjusted life years (QALYs), and costs were represented in Canadian dollars. Clinical inputs were derived from the REFLECT trial, with outcomes extrapolated using parametric survival models. EQ-5D data collected in REFLECT were used to determine health state utility values, and estimates of resource use came from a survey of clinicians. The model predicted incremental costs of-$5,021 and incremental QALYs of 0.17, making lenvatinib dominant over sorafenib. The model demonstrates lenvatinib to be a cost-effective use of resources versus sorafenib in Canada for the treatment of uHCC. Overall costs are lower compared with sorafenib, while health benefits are greater, with modelled progression-free and overall survival extended by 4.1 and 2.6 months in the lenvatinib arm, respectively.
