Published online Apr 15, 2026. doi: 10.4251/wjgo.v18.i4.113266
Revised: November 23, 2025
Accepted: January 14, 2026
Published online: April 15, 2026
Processing time: 231 Days and 7.4 Hours
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and represents a significant health burden in China, where selecting cost-effective first-line therapies for advanced disease remains critical.
To evaluate the cost-effectiveness of seven high-efficacy regimens for advanced HCC from the perspective of the Chinese healthcare system.
A systematic network meta-analysis was conducted on 23 first-line treatment regimens from 22 phase III randomized controlled trials. Seven high-efficacy regimens were then subjected to cost-effectiveness evaluation using a Markov model. Hazard ratios for progression-free survival and overall survival specific to Chinese subgroups were preferentially employed to derive survival parameters; when unavailable, Asian subgroup data were substituted to maintain population relevance. The analysis incorporated survival data, adverse event profiles, and direct medical costs.
The network meta-analysis ranked lenvatinib plus transarterial chemoembolization (L + T) highest for both progression-free survival and overall survival [surface under the cumulative ranking curve: (1) 100%; and (2) 99.4%, respec
L + T emerges as the optimal first-line therapy for advanced HCC in China, offering an effective balance between clinical outcomes and cost-effectiveness.
Core Tip: The economic evaluation of various first-line treatment regimens for advanced hepatocellular carcinoma is crucial, yet such analyses remain scarce. This study conducted a network meta-analysis of 23 first-line regimens for advanced hepatocellular carcinoma and subsequently performed a cost-effectiveness analysis on seven highly efficacious regimens from the perspective of the Chinese healthcare system. The results indicated that lenvatinib combined with transarterial chemoembolization emerged as the most favorable first-line treatment under current economic conditions in China, achieving a 67.9% probability of being the most cost-effective option. This study contributes a novel perspective to inform clinical decision-making for healthcare professionals.