ArticleFrontiers in public health2026
Cost-effectiveness of tremelimumab plus durvalumab versus sorafenib for unresectable hepatocellular carcinoma in China: an economic evaluation based on five-year overall survival data from the HIMALAYA trial.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To assess the cost-effectiveness of tremelimumab plus durvalumab [the Single Tremelimumab Regular Interval Durvalumab (STRIDE) regimen] versus sorafenib as first-line treatment for unresectable hepatocellular carcinoma in China using 5-year follow-up data from the HIMALAYA trial. Methods: A three-state partitioned survival model comprising progression-free survival, progressed disease, and death was developed from the perspective of the Chinese healthcare system. Individual patient data were reconstructed from the published Kaplan-Meier curves from the HIMALAYA trial and used to estimate and extrapolate progression-free and overall survival. The model used 28-day cycles, a 10-year base-case time horizon, and an annual discount rate of 4.5%. Only direct medical costs were included and expressed in 2025 United States dollars. The willingness-to-pay threshold was 27,906 USD per quality-adjusted life-year (QALY). One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed. Results: In the base-case analysis, the STRIDE regimen and sorafenib yielded 1.6937 and 1.2900 QALYs at total costs of 93,507.00 and 8,081.94 USD, respectively. The STRIDE regimen provided an additional 0.4037 QALYs at an incremental cost of 85,425.06 USD, resulting in an incremental cost-effectiveness ratio (ICER) of 211,596.11 USD/QALY. The cost of durvalumab was the principal driver of the ICER. At the prespecified willingness-to-pay threshold, the probability that STRIDE was cost-effective was 0.0%. The ICER remained above the threshold in the durvalumab patient assistance program, 15-year time-horizon, alternative overall survival extrapolation, mixture-cure, and lower progressed-disease utility scenarios. The price of durvalumab would need to decrease by 92.34% for the ICER to reach the prespecified threshold. In contrast, reducing the price of tremelimumab to zero was insufficient to lower the ICER to the threshold when the price of durvalumab remained unchanged. Conclusion: Although the STRIDE regimen improved health outcomes compared with sorafenib, it was not cost-effective at current prices in China. The findings suggest that its clinical value has not yet been matched by its economic value, primarily because of the high cumulative cost of durvalumab maintenance therapy. Future pricing, reimbursement, and patient assistance strategies should focus on reducing the cost of maintenance treatment to improve the value for money of the STRIDE regimen.
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