{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:16:38Z","timestamp":1782836198977,"version":"3.54.5"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The CheckMate 9DW trial showed that nivolumab plus ipilimumab (NIVO\u202f+\u202fIPI) improves overall survival over lenvatinib or sorafenib (LEN\/SOR) in patients with unresectable hepatocellular carcinoma (uHCC). We evaluated the cost-effectiveness of NIVO\u202f+\u202fIPI versus LEN\/SOR from payer perspectives in the United States (US) and China, explicitly aiming to inform reimbursement and price-negotiation decisions in each setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on the overall and subgroup data from the CheckMate 9DW trial, we developed a partitioned survival model to compare the clinical outcomes of NIVO\u202f+\u202fIPI versus LEN\/SOR. Costs included drugs, administration, monitoring, adverse event management, and follow-up care in both the US and China. A lifetime horizon (1-month\u202fcycles) and 2024 US dollars were applied. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) gained. Willingness-to-pay (WTP) thresholds were $150,000\/QALY (US) and $39,933.67\/QALY (China). Model uncertainty was assessed through one-way and probabilistic sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the US, the NIVO\u202f+\u202fIPI regimen generated an incremental gain of 0.68 QALYs at an additional cost of $86,403.43, resulting in an ICER of $127,063.87 per QALY. In the China subgroup, NIVO\u202f+\u202fIPI yielded an incremental gain of 0.94 QALYs with an incremental cost of $35,358.47, corresponding to an ICER of $37,615.40 per QALY. Sensitivity analyses indicated that the ICER was mostly influenced by variations in the discount rate and drug prices. Probabilistic sensitivity analysis demonstrated that the probability of NIVO\u202f+\u202fIPI being cost-effective exceeded 50% at the respective WTP thresholds in both the United States and China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests that NIVO\u202f+\u202fIPI is cost-effective in both the United States and China at current price levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1726477","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:14:04Z","timestamp":1768205644000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Nivolumab plus ipilimumab versus lenvatinib or sorafenib for US and Chinese patients with unresectable hepatocellular carcinoma: a cost-effectiveness analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Qiuji","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1038\/s41572-020-00240-3","article-title":"Hepatocellular 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