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Cost-Effectiveness of Lenvatinib Compared with Sorafenib for the First-Line Treatment of Advanced Hepatocellular Carcinoma in Australia


Background and Objective

In the REFLECT trial, lenvatinib showed superior clinical benefits to sorafenib in terms of progression-free survival and was non-inferior for overall survival in the treatment of advanced hepatocellular carcinoma (HCC). We assessed the cost-effectiveness of lenvatinib compared with sorafenib for patients with advanced HCC in Australia.


A partitioned-survival model was built to perform a cost-effectiveness analysis comparing lenvatinib and sorafenib from an Australian health-system perspective. Survival curves were obtained from the REFLECT trial and fitted with parametric survival functions for extrapolation purposes beyond the trial follow-up. Cost and quality-adjusted life-years (QALYs) were accrued over the 10-year time horizon of the model. Deterministic and probability sensitivity analysis (PSA) were carried out to verify the validity of the model.


Lenvatinib incurred higher costs (A$96,325) and superior health outcomes (QALYs: 1.205), while sorafenib had lower costs (A$92,394) and inferior health outcomes (QALYs: 1.086). Thus, lenvatinib yielded an incremental cost-utility ratio of A$33,028/QALY gained. Further, the results of the PSA found that the probability of lenvatinib being cost-effective at a willingness-to-pay threshold of A$50,000/QALY was 64%.


Our study found that, at current prices, lenvatinib is a cost-effective treatment option compared with sorafenib for the first-line treatment of patients with advanced HCC.

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The authors would like to thank Sundeep Pathak for their assistance in proof-reading the final version of the manuscript and Mussab Fagery for collecting some cost inputs for the model.

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Correspondence to Masnoon Saiyed.

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No specific funding was received for this study.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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Author's contribution

MS conceived the study and developed the model, undertook the analysis, and wrote up the manuscript; TS, JB, MD, and PS helped with model validation and results interpretation, and critically reviewed the manuscript before submission.

Data availability

The authors declare that all input data to parameterize the decision analytic model are available within the article and the OSM. The model can be re-built entirely based on the detailed description of the model structure in the “Method” section (Sect. 2) and information provided.

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Saiyed, M., Byrnes, J., Srivastava, T. et al. Cost-Effectiveness of Lenvatinib Compared with Sorafenib for the First-Line Treatment of Advanced Hepatocellular Carcinoma in Australia. Clin Drug Investig 40, 1167–1176 (2020).

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