Cost-Effectiveness of Lenvatinib in the Treatment of Patients With Unresectable Hepatocellular Carcinomas in Japan: An Analysis Using Data From Japanese Patients in the REFLECT Trial.


Ikeda S(1), Kudo M(2), Izumi N(3), Kobayashi M(4), Azuma M(5), Meier G(6), Pan J(6), Ishii M(5), Kaneko S(7).
Author information:
(1)Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan. Electronic address: [Email]
(2)Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.
(3)Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan.
(4)Department of Hepatology, Toranomon Hospital, Minato-ku, Tokyo, Japan.
(5)Eisai Co, Ltd, Bunkyo-ku, Tokyo, Japan.
(6)Eisai Inc, Woodcliff Lake, NJ, USA.
(7)Department of Gastroenterology, Division of Medical Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.


BACKGROUND: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Japan. Prognosis is poor, and until recently sorafenib was the only treatment option available for patients with unresectable disease. Lenvatinib is the first therapy to demonstrate noninferiority to sorafenib. An analysis was conducted using clinical data from Japanese patients in the phase III REFLECT trial to assess the cost-effectiveness of lenvatinib versus sorafenib for first-line treatment of unresectable HCC in Japan. METHODS: A partitioned survival model was implemented adopting the perspective of the Japanese healthcare system, with costs and outcomes modeled over a lifetime horizon and using a discount rate of 2%, as per Japanese guidelines. Population data from the Japanese subpopulation of REFLECT were used to extrapolate outcomes, and costs and resource use were based on Japanese sources. The Japanese tariff was applied to EQ-5D data collected during the REFLECT clinical trial to obtain utility values reflecting the preferences of the Japanese population. RESULTS: Compared with sorafenib, lenvatinib is dominant because it is associated with a reduction in incremental costs of ¥156 799 and incremental quality-adjusted life-years of 0.31. These results were robust to changes in key assumptions, and probabilistic outcomes aligned with deterministic outcomes. CONCLUSION: Given the use of Japan-specific data in the cost-effectiveness model, it is expected that the use of lenvatinib as a first-line treatment in Japan will be associated with cost savings and improved clinical outcomes versus sorafenib for patients with unresectable HCC.