Efficacy and Cost-Effectiveness of Atezolizumab-Bevacizumab vs Sintilimab-Bevacizumab with TACE in uHCC

Purpose: Atezolizumab plus bevacizumab (Ate/Bev) or sintilimab plus bevacizumab biosimilar (Sin/Bio) combined with transarterial chemoembolization (TACE) shows promising efficacy in unresectable hepatocellular carcinoma (uHCC). This study aimed to evaluate the efficacy, safety, and real-world cost-effectiveness of Ate/Bev-TACE versus Sin/Bio-TACE as first-line therapy for uHCC.

Materials and Methods: This multicenter, real-world study included patients with uHCC treated at five centers in China from November 2020 to June 2024 who received Ate/Bev-TACE or Sin/Bio-TACE as first-line therapy. Stabilized inverse probability of treatment weighting (sIPTW) was applied to reduce confounding. The primary outcomes were overall survival (OS) and cost-effectiveness. Secondary outcomes included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and safety.

Results: A total of 123 patients were analyzed (Ate/Bev-TACE, n=42; Sin/Bio-TACE, n=81). After sIPTW, baseline characteristics were well balanced. Median OS was not reached in either cohort (Ate/Bev: 95% CI, 29.7 months–NE; Sin/Bio: 20.8 months–NE; HR=0.59, 95% CI 0.24–1.42; P=0.2242). The 1- and 2-year OS rates were 91.8% and 82.8% in the Ate/Bev group versus 83.9% and 62.3% in the Sin/Bio group. Median PFS was similar (Ate/Bev vs Sin/Bio: 14.6 m [95% CI, 7.93–33.0] vs 14.8 m [13.6–19.4]; HR=1.32, 95% CI 0.79–2.22; P=0.2458). ORR was comparable (risk difference [RD], Ate/Bev–Sin/Bio = −1.0%; 95% CI, −23.6% to 21.6%; P=0.9317), whereas DCR was numerically higher with Sin/Bio (RD, Ate/Bev–Sin/Bio = −14.5%; 95% CI, −33.7% to 4.7%; P=0.1362). Grade ≥3 adverse events occurred in 18.5% and 18.9% of patients in the Ate/Bev and Sin/Bio groups, respectively. Cost-effectiveness analysis showed that Ate/Bev was dominated by Sin/Bio (incremental quality-adjusted life-years = −0.1640; incremental cost = US $11,492.37).

Conclusion: Ate/Bev-TACE and Sin/Bio-TACE demonstrated comparable efficacy and safety as first-line therapy for uHCC. However, Ate/Bev was not cost-effective and was dominated by Sin/Bio from a Chinese health-system perspective.