In the SHARP trial, 602 patients with HCC were randomized to either sorafenib 400 mg b.i.d. or placebo and both were added Selleckchem KU 57788 to best supportive care (BSC). BSC excluded local therapy such as surgery, radiation, chemoembolization, radiofrequency ablation, percutaneous ethanol injection, cryoablation, and other systemic treatments.
Primary end-points in the study included overall survival (OS) and time to symptomatic progression, and a secondary end-point was time to progression (TTP).10 Results showed that sorafenib significantly prolonged OS and TTP compared to patients in the placebo arm (median OS 10.7 months vs 7.9 months, hazard ratio 0.69, P < 0.001, median TTP 5.5 vs 2.8 months, hazard ratio 0.58, P < 0.001).10,11 Sorafenib was also found to be a well-tolerated treatment with manageable adverse events (AE). Thus, sorafenib was the first systematic agent to show survival JNK inhibitor benefit in the advanced HCC patient population and as a result, the only systemic therapy approved by the Food and Drug Administration (FDA) for the treatment of advanced HCC. The aim of this study was to assess the cost-effectiveness of sorafenib in the treatment of advanced
HCC compared to BSC from the US third-party-payer perspective. The cost and health outcomes associated with both treatments, and the potential advantages and cost-effectiveness of using sorafenib as an active therapy over palliative care, were estimated in this target patient population. Currently, cost-effectiveness evaluations are widely used in many countries around the world and it may become an integral part of health technology assessment
in the USA,12 especially after the new health-care reform that aims for universal coverage. An economic model was developed in Microsoft Excel to evaluate the potential costs, health outcomes, and cost-effectiveness of sorafenib in the treatment of advanced HCC. Based on the SHARP study, the model considered adult patients (18 years and older) diagnosed with HCC who had: A life expectancy of at least 12 weeks; Given that there are no other agents 上海皓元 besides sorafenib that have demonstrated significant OS benefit1 or have been approved for this patient population by the FDA,13 sorafenib was compared to BSC. BSC incorporated medical staff visits, hospitalizations, and laboratory and radiology tests. The analysis was conducted from the perspective of a third-party managed-care payer in the USA. Hence, only direct medical costs were included. The time horizon for estimating cost-effectiveness, or the follow-up time for the model, should be sufficiently long to reflect all important differences in costs and outcomes between the technologies being compared. As HCC is a chronic disease, costs and outcomes accumulate over the patient’s lifetime.