Immune checkpoint inhibitors (ICIs) have recently been introduced into the treatment algorithm of patients with hepatocellular carcinoma (HCC). However, the cost effectiveness of ICIs compared with pre-existing therapies for HCC has not been assessed. We performed a meta-analysis to understand the incremental cost effectiveness of ICIs compared with sorafenib.

PubMed, Embase, Medline, Scopus, and CINAHL databases were searched (2000–2022). The incremental cost, incremental effectiveness, incremental cost effectiveness ratio (ICER) of ICI compared with sorafenib and willingness to pay (WTP) were extracted from each study. The variables were then used to derive the incremental net benefit (INB). Random-effect meta-analysis was then conducted to derive the pooled INB of ICI compared with sorafenib.

Five studies (3265 patients, 82.1 % male) met the inclusion criteria. All the studies assessed the cost effectiveness of ICIs compared to sorafenib. Studies used Quality adjusted life years to assess the incremental effectiveness. Studies reported an ICER ranging from $21,000 to $221,000 of ICIs compared with Sorafenib. Four out of five studies reported that ICI had a higher ICER compared to sorafenib at WTP $150,000. The overall pooled INB was US$-42,000 (95 % CIUS$-96,000, US$11,528) suggesting that ICI was not cost effective compared with sorafenib.

When compared with sorafenib, ICIs are not a cost-effective option for systemic therapy for patients with HCC. More work focusing on cost effective options for patients with HCC is warranted.