OBJECTIVE To evaluate the cost-effectiveness of camrelizumab plus rivoceranib versus atezolizumab plus bevacizumab as first-line treatment for unresectable hepatocellular carcinoma.

METHODS Data from the Chinese subgroup of the IMbrave 150 trial and the full CARES 310 trial were used. Several parametric survival models were compared, and the optimal model was selected to fit the survival curves. A fractional polynomial model was used to calculate time-varying hazard ratios for indirect comparison. A partitioned survival model was used for decision analysis. Deterministic and probabilistic sensitivity analyses were performed, and tornado diagrams, cost-utility scatter plots, and cost-utility acceptability curves were generated.

RESULTS The camrelizumab plus rivoceranib group had a total cost of CNY 117875 and a total utility of 1.11 QALY; the atezolizumab plus bevacizumab group had a total cost of CNY 633169 and a total utility of 0.95 QALY. The incremental cost-effectiveness ratio for camrelizumab plus rivoceranib versus atezolizumab plus bevacizumab was CNY 3136265 per QALY gained, with an incremental net monetary benefit of CNY 562489. The camrelizumab-based regimen was less costly and yielded higher total utility compared with the atezolizumab-based regimen.

CONCLUSION Compared with atezolizumab plus bevacizumab, camrelizumab plus rivoceranib as first-line treatment for unresectable HCC is economically advantageous in the Chinese population.