肝细胞癌（HCC）是全世界癌症相关死亡的主要原因之一，尤其在中国带来了沉重的社会经济负担。几种免疫联合疗法在不可切除的肝癌一线治疗中显示出良好的疗效，并广泛应用于临床实践。然而，哪种组合最实惠尚不清楚。我们的研究从中国支付者的角度评估了免疫组合作为不可切除的 HCC 患者一线治疗的成本效益。根据五项多中心、III 期、开放标签、随机试验（喜马拉雅）建立了马尔可夫模型、IMbrave150、ORIENT-32、CARES-310、LEAP-002），研究 tremelimumab 加 durvalumab (STRIDE)、atezolizumab 加贝伐单抗 (A  B)、信迪利单抗加贝伐单抗生物仿制药 (IBI305) (S  B)、camrelizumab 的成本效益加利沃塞尼布 (C  R) 和派姆单抗加乐伐替尼 (P  L)。包括三种疾病状态：无进展生存期（PFS）、疾病进展（PD）以及死亡。医疗费用检索自华西医院、已发表文献或红皮书。评估成本效益比（CER）和增量成本效益比（ICER）以比较不同组合之间的成本。进行敏感性分析以评估模型的稳健性。C  R、S  B、P  L、A  B和STRIDE的总成本和质量调整生命年（QALY）分别为12,109.27美元和0.91美元、26,961.60美元和1.12美元、55,382.53美元和0。 83 、 70,985.06 美元和 0.90 美元、84,589.01 美元和 0.73 美元，导致最具成本效益的策略是 C  R，每个 QALY 的 CER 为 13,306.89 美元，其次是 S  B，每个 QALY 的 CER 为 24,072.86 美元。与C  R相比，S  B策略的ICER为每QALY 70,725.38美元，当愿意支付门槛超过73,500美元/QALY时，该策略将成为最具成本效益的。亚组分析中，Leap-002试验应用亚洲结果，模型结果与全球数据相同。在敏感性分析中，随着参数的变化，结果是稳健的。作为HCC一线全身治疗中最有前景的免疫联合疗法之一，卡瑞利珠单抗联合利沃塞尼布证明有可能成为最具成本效益的策略，这需要进一步的研究，以便最好地为现实世界的临床实践提供信息。© 2024 作者。约翰·威利出版的癌症医学

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death all over the world, and brings a heavy social economic burden especially in China. Several immuno-combination therapies have shown promising efficacy in the first-line treatment of unresectable HCC and are widely used in clinical practice. Nevertheless, which combination is the most affordable one is unknown. Our study assessed the cost-effectiveness of the immuno-combinations as first-line treatment for patients with unresectable HCC from the perspective of Chinese payers.A Markov model was built according to five multicenter, phase III, open-label, randomized trials (Himalaya, IMbrave150, ORIENT-32, CARES-310, LEAP-002) to investigate the cost-effectiveness of tremelimumab plus durvalumab (STRIDE), atezolizumab plus bevacizumab (A + B), sintilimab plus bevacizumab biosimilar (IBI305) (S + B), camrelizumab plus rivoceranib (C + R), and pembrolizumab plus lenvatinib (P + L). Three disease states were included: progression free survival (PFS), progressive disease (PD) as well as death. Medical costs were searched from West China Hospital, published literatures or the Red Book. Cost-effectiveness ratios (CERs) and incremental cost-effectiveness ratios (ICERs) were evaluated to compare costs among different combinations. Sensitivity analyses were performed to assess the robust of the model.The total cost and quality-adjusted life years (QALYs) of C + R, S + B, P + L, A + B and STRIDE were $12,109.27 and 0.91, $26,961.60 and 1.12, $55,382.53 and 0.83, $70,985.06 and 0.90, $84,589.01 and 0.73, respectively, resulting in the most cost-effective strategy of C + R with CER of $13,306.89 per QALY followed by S + B with CER of $24,072.86 per QALY. Compared with C + R, the ICER of S + B strategy was $70,725.38 per QALY, which would become the most cost-effective when the willing-to-pay threshold exceeded $73,500/QALY. In the subgroup analysis, with the application of Asia results in Leap-002 trial, the model results were the same as global data. In the sensitivity analysis, with the variation of parameters, the results were robust.As one of the promising immuno-combination therapies in the first-line systemic treatment of HCC, camrelizumab plus rivoceranib demonstrated the potential to be the most cost-effective strategy, which warranted further studies to best inform the real-world clinical practices.© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.