Atezolizumab plus bevacizumab versus sorafenib as first‐line treatment for unresectable hepatocellular carcinoma: a cost‐effectiveness analysis

Dear Editor, Liver cancer is the third leading cause of cancer deaths worldwide and accounted for 8.9% of all neoplasms, as shownby theGlobal Burden ofDisease Study 2017 [1].Hepatocellular carcinoma (HCC) comprises 75%-85% of liver cancers [2]. The abysmal statistic is partly contributed by the fact that only 30%-40% of all patients are diagnosed at early stages that are amenable to potentially curative treatments [3]. For over a decade, the availability of new agents, such as lenvatiniband sorafenib-based targeted therapy, has significantly improved the outcome of patients with advanced HCC, prolonging the median overall survival (OS) from 4-8 months to 10-15 months [4, 5]. However, the therapeutic options for advancedHCC are still limited, and the prognosis is poor. The IMbrave150 study demonstrated the efficacy and safety of atezolizumab plus bevacizumab versus sorafenib in advanced metastatic or unresectable HCC [6]. The results indicated that atezolizumab plus bevacizumab achieved notably favorable progression-free survival (PFS) and OS compared with sorafenib. The rate of grade 3 or higher adverse events (AEs) was comparable between the atezolizumab plus bevacizumab group and the sorafenib group (56.5% vs. 55.1%). Thus, the combination of atezolizumab and bevacizumab seemed to be an attractive alternative first-line treatment for advanced HCC. However, considering cost-effectiveness is crucial in medical decisions for physicians and policy decision-makers to reasonably allocate limited health resources. To reduce the price ofmedicines, the Chinese government adopted a process of centralized strategic price negotiation with pharmaceutical companies underpinned by health technology