PMID- 36713376
OWN - NLM
STAT- MEDLINE
DCOM- 20230131
LR  - 20230202
IS  - 1664-3224 (Electronic)
IS  - 1664-3224 (Linking)
VI  - 13
DP  - 2022
TI  - Immunotherapy or targeted therapy as the first-line strategies for unresectable 
      hepatocellular carcinoma: A network meta-analysis and cost-effectiveness 
      analysis.
PG  - 1103055
LID - 10.3389/fimmu.2022.1103055 [doi]
LID - 1103055
AB  - INTRODUCTION: The existence of many phase III randomized controlled trials (RCTs) 
      of first-line treatment for unresectable hepatocellular carcinoma (HCC) puzzle 
      doctors and patients in choosing the most effective treatment strategies. We 
      aimed to assess the efficacy, safety, and cost-effectiveness of immunotherapy or 
      targeted therapy as the first-line strategy for unresectable HCC. METHODS: The 
      included clinical trials were retrieved from PubMed, Embase, the Cochrane 
      library, and Web of Science databases, in which immunotherapy or targeted therapy 
      was regarded as the first-line treatment for unresectable HCC, published in 
      English between January 1, 2010, and September 20, 2022. We conducted a network 
      meta-analysis (NMA) and cost-effectiveness analysis (CEA) from the Chinese 
      payer's perspective. Overall survival (OS), progression-free survival (PFS), the 
      ranks of different treatments using P-score, and adverse events (AEs) were 
      evaluated by NMA. Total costs, life-years (LYs), quality-adjusted life-years 
      (QALYs), and incremental cost-benefit ratio (ICER) were estimated from 15-year 
      Markov models developed by CEA. RESULTS: We identified 2,825 records, including 
      11,796 patients, from 15 RCTs. The NMA revealed that sintilimab plus a 
      bevacizumab biosimilar (HR, 0.57; 95% CI, 0.43 to 0.75; P = 0.96) and 
      camrelizumab plus rivoceranib (HR, 0.56; 95% CI, 0.41 to 0.66; P = 0.94) could 
      lead to great improvements in OS and PFS compared with sorafenib-related 
      survival. The CEA indicated that tislelizumab increased by 0.220 QALYs (0.312 
      LYs) and decreased by $1,938 compared with sorafenib, which yielded ICERs of 
      -$8,809/QALY (-$2,612/LY). Sensitivity analysis showed that the model was stable. 
      CONCLUSION: Sintilimab plus a bevacizumab biosimilar and camrelizumab plus 
      rivoceranib significantly prolonged OS and PFS, respectively. Further considering 
      the pharmacoeconomics factors, tislelizumab is the most cost-effective first-line 
      treatment strategy for unresectable HCC in China.
CI  - Copyright (c) 2023 Liu, Zhu and Zhu.
FAU - Liu, Kun
AU  - Liu K
AD  - Department of Oncology, Xiangya Hospital, Central South University, Changsha, 
      Hunan,  China.
FAU - Zhu, Youwen
AU  - Zhu Y
AD  - Department of Oncology, Xiangya Hospital, Central South University, Changsha, 
      Hunan,  China.
FAU - Zhu, Hong
AU  - Zhu H
AD  - Department of Oncology, Xiangya Hospital, Central South University, Changsha, 
      Hunan,  China.
AD  - National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, 
      Central South University, Changsha, Hunan,  China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20230111
PL  - Switzerland
TA  - Front Immunol
JT  - Frontiers in immunology
JID - 101560960
RN  - 9ZOQ3TZI87 (Sorafenib)
RN  - 2S9ZZM9Q9V (Bevacizumab)
RN  - 0 (Biosimilar Pharmaceuticals)
SB  - IM
MH  - Humans
MH  - *Carcinoma, Hepatocellular/drug therapy
MH  - Sorafenib/therapeutic use
MH  - Cost-Effectiveness Analysis
MH  - Bevacizumab/therapeutic use
MH  - Network Meta-Analysis
MH  - *Biosimilar Pharmaceuticals/therapeutic use
MH  - *Liver Neoplasms/drug therapy
MH  - Immunotherapy
PMC - PMC9874298
OTO - NOTNLM
OT  - cost-effectiveness analysis
OT  - immunotherapy
OT  - network meta-analysis
OT  - targeted therapy
OT  - unresectable hepatocellular carcinoma
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/01/31 06:00
MHDA- 2023/02/01 06:00
PMCR- 2022/01/01
CRDT- 2023/01/30 04:15
PHST- 2022/11/19 00:00 [received]
PHST- 2022/12/27 00:00 [accepted]
PHST- 2023/01/30 04:15 [entrez]
PHST- 2023/01/31 06:00 [pubmed]
PHST- 2023/02/01 06:00 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 10.3389/fimmu.2022.1103055 [doi]
PST - epublish
SO  - Front Immunol. 2023 Jan 11;13:1103055. doi: 10.3389/fimmu.2022.1103055. 
      eCollection 2022.