Abstract
This study aimed to assess the cost-effectiveness of penpulimab plus anlotinib therapy relative to sorafenib for advanced hepatocellular carcinoma (HCC) from the Chinese healthcare system perspective. The study utilized a partitioned survival model to evaluate the cost-effectiveness of anlotinib plus penpulimab over a 10-year time horizon with a cycle period of 3 weeks for advanced HCC. The cost analysis considered direct costs. The willingness-to-pay (WTP) threshold was set at three times China's 2025 per capita gross domestic product (GDP), amounting to 41,876.05 USD per quality-adjusted life year (QALY). Sensitivity analyses were conducted to assess the impact of parameter variations on the study outcomes. The first-line treatment with penpulimab plus anlotinib resulted in an incremental 0.66 QALYs gained and incremental costs of 39,421.98 USD compared with sorafenib. The combination therapy of penpulimab plus anlotinib was determined to have an incremental cost-effectiveness ratio (ICER) of 59,730.27 USD per QALY. Sensitivity analysis confirmed the robustness of our findings to variations in key parameters. Penpulimab combined with anlotinib is not a cost-effective first-line treatment strategy for patients with advanced HCC relative to sorafenib at the current WTP threshold in China.