{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T20:43:03Z","timestamp":1784666583831,"version":"3.55.0"},"reference-count":38,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2022JJ80114"],"award-info":[{"award-number":["2022JJ80114"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,4,11]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      In a recently published 4-year overall survival (OS) update from the phase III clinical trial named HIMALAYA (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT03298451\">NCT03298451<\/jats:ext-link>\n                      ), single tremelimumab plus regular interval durvalumab (a regimen termed STRIDE) demonstrated significantly improved OS compared with sorafenib in the first-line setting of unresectable hepatocellular carcinoma (uHCC). Although dual immunotherapy represents a novel treatment option for uHCC, the economic implications of these high-priced drugs require further exploration. This study aimed to evaluate the cost-effectiveness of STRIDE in uHCC to inform first-line treatment decisions and help allocate medical resources most effectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Using a partitioned survival model, we conducted a cost-effectiveness analysis comparing STRIDE to sorafenib in the first-line treatment of uHCC. Clinical information was gathered from the phase III HIMALAYA trial. Costs and health state utilities data were derived from previous literature. Uncertainty of the model was assessed through one-way sensitivity analysis and probabilistic sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Total costs, life years, quality-adjusted life years (QALYs), incremental QALYs and incremental cost-effectiveness ratio (ICER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>US payer perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>393 participants in the STRIDE group and 389 participants in the sorafenib group who were diagnosed with uHCC and had no previous systemic treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Single-dose tremelimumab plus monthly durvalumab (STRIDE) versus sorafenib.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Treatment with STRIDE provided an additional 0.51 QALYs at an incremental total cost of United States dollar ($)9812. The ICER of STRIDE was $19 239 per QALY compared with sorafenib, which falls below the willingness-to-pay threshold of $150 000 per QALY. Sensitivity analyses indicated that our results were robust to the variation ranges of key inputs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this economic evaluation comparing two first-line systemic therapies for uHCC patients, STRIDE was cost-effective compared with sorafenib from a US payer perspective. Our study is the first to demonstrate that immunotherapy can provide both survival benefits and economic viability in uHCC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090992","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T02:35:20Z","timestamp":1745980520000},"page":"e090992","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Tremelimumab plus durvalumab versus sorafenib in first-line treatment of unresectable hepatocellular carcinoma: a cost-effectiveness analysis from the US payer perspective"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct03298451","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5053-0315","authenticated-orcid":false,"given":"Shuqiao","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oncology, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanhua","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Oncology, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4039-306X","authenticated-orcid":false,"given":"Jian","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"2025121222021336000_15.4.e090992.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2025121222021336000_15.4.e090992.2","doi-asserted-by":"crossref","first-page":"554","DOI":"10.21147\/j.issn.1000-9604.2022.06.02","article-title":"Burden of liver cancer: From epidemiology to prevention","volume":"34","author":"Li","year":"2022","journal-title":"Chin J Cancer Res"},{"key":"2025121222021336000_15.4.e090992.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30010-2"},{"key":"2025121222021336000_15.4.e090992.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0708857"},{"key":"2025121222021336000_15.4.e090992.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30207-1"},{"key":"2025121222021336000_15.4.e090992.6","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1080\/17474124.2021.1973431","article-title":"First-line immune checkpoint inhibitor-based combinations in unresectable hepatocellular carcinoma: current management and future challenges","volume":"15","author":"Rizzo","year":"2021","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2025121222021336000_15.4.e090992.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.09.025"},{"key":"2025121222021336000_15.4.e090992.8","doi-asserted-by":"publisher","DOI":"10.1517\/14712598.8.10.1583"},{"key":"2025121222021336000_15.4.e090992.9","doi-asserted-by":"publisher","DOI":"10.1158\/2326-6066.CIR-14-0191"},{"key":"2025121222021336000_15.4.e090992.10","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.immuni.2019.11.003","article-title":"PD-L1:CD80 Cis-Heterodimer Triggers the Co-stimulatory Receptor CD28 While Repressing the Inhibitory PD-1 and CTLA-4 Pathways","volume":"51","author":"Zhao","year":"2019","journal-title":"Immunity"},{"key":"2025121222021336000_15.4.e090992.11","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1159\/000503254","article-title":"Scientific Rationale for Combination Immunotherapy of Hepatocellular Carcinoma with Anti-PD-1\/PD-L1 and Anti-CTLA-4 Antibodies","volume":"8","author":"Kudo","year":"2019","journal-title":"Liver Cancer"},{"key":"2025121222021336000_15.4.e090992.12","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2100070","article-title":"Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma","volume":"1","author":"Abou-Alfa","year":"2022","journal-title":"NEJM Evid"},{"key":"2025121222021336000_15.4.e090992.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2024.02.005"},{"key":"2025121222021336000_15.4.e090992.14","unstructured":"National Comprehensive Cancer Network . 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