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The STRIDE regimen (tremelimumab plus durvalumab) demonstrated superior survival benefits over sorafenib in the HIMALAYA trial. However, its cost-effectiveness within the Chinese healthcare system remains unverified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost-effectiveness of first-line STRIDE versus sorafenib for unresectable HCC from the perspective of the Chinese healthcare payer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive cost-effectiveness analysis was conducted using both partitioned survival (PartSA) and Markov state-transition models over a 10-year time horizon. Clinical efficacy parameters were derived from reconstructed HIMALAYA trial survival data. Direct medical costs were estimated based on post-negotiation drug pricing in China and published sources. Health utility weights were sourced from established literature. Scenario analyses (50% price reduction, 0% discount rate) and comprehensive deterministic and probabilistic sensitivity analyses (PSA) were performed to evaluate model uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the base-case analysis, the STRIDE regimen yielded incremental cost-effectiveness ratios (ICERs) of $204,713.55\/QALY in the PartSA model and $208,385.86\/QALY in the Markov model, both substantially exceeding China\u2019s willingness-to-pay threshold (3\u00d7 GDP per capita, $36,975\/QALY). Under a 50% price reduction scenario, the ICER dropped to $87,351.95\/QALY but remained non-cost-effective. Probabilistic sensitivity analysis demonstrated a\u2009&lt;\u200920% likelihood of STRIDE being cost-effective across tested scenarios. Key cost drivers included drug acquisition costs and progression-free utility values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Under current pricing, the STRIDE regimen is not cost-effective as a first-line treatment for unresectable HCC in China. While price concessions improve affordability, exploration of value-based pricing and future biomarker-guided patient stratification could be evaluated to optimize economic viability. The dual-model concordance reinforces the robustness of these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-05305-3","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T02:34:22Z","timestamp":1788748462000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness analysis of durvalumab combined with tremelimumab versus sorafenib as first-line treatment for unresectable Hepatocellular carcinoma in China: a dual-model approach utilizing partitioned survival and markov models"],"prefix":"10.1186","volume":"26","author":[{"given":"Ruixuan","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3294-4175","authenticated-orcid":false,"given":"Qing","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"issue":"3","key":"5305_CR1","first-page":"209","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL, et al. 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This study is a pharmacoeconomic modeling and cost-effectiveness analysis based entirely on published secondary literature and publicly available clinical trial data (HIMALAYA trial, NCT03298451). No individual human participants, animals, or identifiable personal data were directly involved or collected by the authors; therefore, institutional ethical review and formal informed consent were not required for this study. All clinical data utilized were derived from the original Phase III HIMALAYA trial, in which ethical approval was granted by the relevant institutional review boards\/ethics committees and written informed consent was obtained from all enrolled participants in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"631"}}