AUTHOR=Fang Rui , Liang Jiajun , Wang Tieqiao , Sheng Feifeng , Xu Jun 

TITLE=Economic evaluation of anlotinib plus penpulimab vs. sorafenib as first-line therapy for unresectable hepatocellular carcinoma in China

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1634266

DOI=10.3389/fpubh.2025.1634266

ISSN=2296-2565

ABSTRACT=IntroductionWhile the APOLLO trial confirmed the clinical efficacy of first-line anlotinib plus penpulimab in unresectable hepatocellular carcinoma (HCC), its economic impact on China’s healthcare system remains underexplored. This study was conducted to evaluate the cost-effectiveness of this novel combination vs. sorafenib from the perspective of the Chinese healthcare system.MethodsA partitioned survival model with three health states was developed to simulate economic outcomes for patients with advanced HCC. Survival data were derived from the APOLLO trial using parametric fitting. Direct medical costs and utility values were obtained from local public databases and the published literature. The primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) evaluated against the willingness-to-pay (WTP) threshold of $40334.05/QALY. Model robustness was assessed through deterministic and probabilistic sensitivity analyses (PSA).ResultsThe base-case analysis revealed that anlotinib plus penpulimab incurred a total cost of $25681.69 and yielded 1.42 QALYs, compared with sorafenib’s total cost of $18082.48 and 1.19 QALYs. This resulted in an incremental cost of $7599.21 and an incremental effectiveness of 0.22 QALYs, resulting in an ICER of $34050.28/QALY, which is below the predefined WTP threshold. Sensitivity analyses identified anlotinib treatment duration (cycles) and progression-free survival (PFS) utility values as key drivers of model variability. The PSA indicated an 85.9% probability of cost-effectiveness at the WTP threshold.ConclusionAnlotinib plus penpulimab represents a potentially cost-effective first-line treatment for advanced HCC from a Chinese healthcare system perspective. These findings support incorporating this regimen into guidelines for selecting cost-effective immunotherapeutic strategies and provide evidence to inform decision-making about resource allocation for advanced HCC management.