Background: Sorafenib is not included to the National List of Essential Medicines [NLEMs] and the program for the high-
cost cancer (Onco Prior Authorization Program, OCPA) medicine. There have been no studies on the cost-effectiveness of Sorafenib treatment for these reimbursement policies in Thailand.

Objective: To evaluate the lifetime cost-effectiveness of Sorafenib treatment versus the palliative care in the advanced hepatocellular carcinoma patients based on the retrospective real practice
data at Chulabhorn Hospital.

Materials and Methods: An analysis of cost-effectiveness was conducted according to a third-party payer perspective. Heath-state transition probabilities and resources use were retrieved from the
Chulabhorn Hospital's computerized database, which was queried from 1 January 2009 through 31 January 2014 to assign patients to Sorafenib group or palliative group. The transition probabilities and costs were determined until 28 February 2017. A Markov model was developed to estimate lifetime costs and quality-adjusted life years. The incremental cost-effectiveness ratio, including the sensitivity analysis, was determined.

Results: Using base-case and probabilistic analysis, Sorafenib treatment was more costly and less effective compared with palliative care.

Conclusion: Palliative therapies were more beneficial and economically for managing for patients with advanced hepatocellular carcinoma compared with Sorafenib treatment.

Keywords: Economic evaluation, Cancer, Cost-effectiveness, Sorafenib, Hepatocellular Carcinoma