Economic Evaluation of Sorafenib Treatment of Patients with Advanced Hepatocellular Carcinoma at Chulabhorn Hospital

Pannapa Sangmala PhD1, Wisut Lamlertthon MD, MHSc2,3, Prapasri Siri MEcon1, Sirima Jaroenpatarapesaj BNS, MA4

Affiliation : 1 Office of Health Economics Research, Division of Research and International Relations, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand 2 Department of Medicine, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand 3 Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand 4 Nursing Division, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand

Background : Sorafenib is not included to the National List of Essential Medicines [NLEMs] and the program for the high- cost cancer (Onco Prior Authorization Program, OCPA) medicine. There have been no studies on the cost-effectiveness of Sorafenib treatment for these reimbursement policies in Thailand.
Objective : To evaluate the lifetime cost-effectiveness of Sorafenib treatment versus the palliative care in the advanced hepatocellular carcinoma patients based on the retrospective real practice data at Chulabhorn Hospital.
Materials and Methods : An analysis of cost-effectiveness was conducted according to a third-party payer perspective. Heath-state transition probabilities and resources use were retrieved from the Chulabhorn Hospital’s computerized database, which was queried from 1 January 2009 through 31 January 2014 to assign patients to Sorafenib group or palliative group. The transition probabilities and costs were determined until 28 February 2017. A Markov model was developed to estimate lifetime costs and quality-adjusted life years. The incremental cost-effectiveness ratio, including the sensitivity analysis, was determined.
Results : Using base-case and probabilistic analysis, Sorafenib treatment was more costly and less effective compared with palliative care.
Conclusion : Palliative therapies were more beneficial and economically for managing for patients with advanced hepatocellular carcinoma compared with Sorafenib treatment.

Keywords : Economic evaluation, Cancer, Cost-effectiveness, Sorafenib, Hepatocellular Carcinoma

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