{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:07:43Z","timestamp":1780358863442,"version":"3.54.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Vinhealth","award":["1111\/H\u0110TCG\/VH-THANG_2020"],"award-info":[{"award-number":["1111\/H\u0110TCG\/VH-THANG_2020"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate cost-effectiveness of lenvatinib compared with sorafenib as first-line treatment in unresectable hepatocellular carcinoma (HCC) patients in Vietnam from a perspective of the public third-party payer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three-health state partitioned survival model was developed to compare costs and health outcomes of lenvatinib and sorafenib in unresectable advanced HCC patients over a 10-year time horizon, using a cycle length of 28-day. Clinical data on efficacy and safety of lenvatinib and sorafenib from the REFLECT trial was used to extrapolate outcomes beyond the follow-up period, while medication costs and health care resources were estimated based on local data and clinical experts\u2019 consultations. A discount rate of 3% was applied to both costs and outcomes. Parameter uncertainty was explored using one-way sensitivity analysis and probabilistic sensitivity analysis. The impact of different time horizons and different approaches to extrapolate survival time were examined in scenario analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In unresectable HCC patients, lenvatinib gained more 0.28 life-years (LYs) equaling to 0.21 quality-adjusted life-years (QALYs) compared with sorafenib. Without consideration of reimbursement rate for all medications and co-insurance, usage of lenvatinib led to an increase of 3,451.3 USD. Therefore, lenvatinib was not cost-effective compared with sorafenib, with an incremental cost-effectiveness ratio (ICER) of 16,114.5 USD\/QALY. However, if lenvatinib was reimbursed at the same rate as sorafenib (50%), it became cost-effective, with an ICER of 8,307.6 USD\/QALY. Results from the base-case analysis were robust in different sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With a significant improvement in progression-free survival, lenvatinib gained more LYs and QALYs compared with sorafenib. At the same reimbursement rate of sorafenib of 50%, lenvatinib was cost-effective from the perspective of the third-party payer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345212","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T17:37:45Z","timestamp":1775237865000},"page":"e0345212","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-utility analysis of lenvatinib and sorafenib for the first-line treatment of unresectable hepatocellular carcinoma in Vietnam: Evidence from a lower-middle income country"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6248-2568","authenticated-orcid":true,"given":"Thang Xuan","family":"Do","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0792-0913","authenticated-orcid":true,"given":"Ha Thi","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2830-5677","authenticated-orcid":true,"given":"Phuong Thi Lan","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai Thi Tuyet","family":"Kieu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuan Viet","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Van Nu Hanh","family":"Pham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"pone.0345212.ref001","unstructured":"International Agency for Research on Cancer. 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