A systematic review of comparative economic analyses of systemic therapies for hepatocellular carcinoma

Abstract

Aim: We conducted a systematic synthesis of comparative economic evaluations assessing systemic therapies for hepatocellular carcinoma (HCC) to establish their cost-effectiveness.

Methods: We searched six bibliographic databases for English-language studies published from 2015 through June 2025. Extracted endpoints included counts and types of regimens deemed cost-effective, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and ICER relative to national willingness-to-pay (WTP) thresholds.

Results: Fifty-four studies met the inclusion criteria, producing four treatment subgroupings and 35 distinct treatment comparisons. QALYs were reported in 96.3% of articles, ICERs in 90.7%, and WTP thresholds in 92.6%. Fourteen regimens (40.0% of comparisons) were judged cost-effective. Regimens that included immunotherapy were more often cost-effective, while lenvatinib outperformed sorafenib in most analyses. Nearly all studies (94.4%) relied, to varying degrees, on data from 14 randomized controlled trials; 48.1% focused on the Chinese healthcare environment; 27.8% used a lifetime horizon; and 38.9% reported a median [interquartile range (IQR)] horizon of 10 (9) years. Only 5.5% adopted a societal perspective.

Conclusion: Less than half of the evaluated systemic therapies were cost-effective, focusing mainly on immunotherapy-based regimens. Harmonized methodological standards are needed to ensure that economic evaluations keep pace with real-world practice as systemic treatments become more widely adopted. [International Platform of Systematic Review and Meta-Analysis Protocols (INPLASY) registration number: 2025100049].

Keywords

Hepatocellular carcinoma / treatment / systemic therapy / immunotherapy / oral agents / cost / cost-effectiveness

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