ArticleBMC gastroenterology2026
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.
Article in BMC gastroenterology, 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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4 authors.
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Abstract
backgroundHepatocellular 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.
objectiveTo evaluate the cost-effectiveness of first-line STRIDE versus sorafenib for unresectable HCC from the perspective of the Chinese healthcare payer.
methodsA 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.
resultsIn 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.
conclusionUnder 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.
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