Objective  To compare the cost-utility of tislelizumab and sorafenib in the first-line treatment of advanced unresectable hepatocellular carcinoma, and to provide a reference for the selection of treatment regimens from the perspective of pharmacoeconomics.

Methods  A partitioned survival model was used to simulate the survival status of patients using tislelizumab or sorafenib within 10 years, and the cost and health output were calculated respectively to obtain the incremental cost-utility ratio (ICUR). The 3 times China's per capita gross domestic product (GDP) in 2022 was taken as the threshold for willingness to pay (WTP).

Results  During the simulation period, the ICER of tislelizumab versus sorafenib was 280 691.4 yuan/quality-adjusted life year (QALY), which was significantly higher than that of the sorafenib group, which had obvious economic performance. Univariate sensitivity analysis showed that the incidence of grade 3 or above adverse reactions in the tislelizumab group, the cost of tislelizumab, and the incidence of grade 3 or higher adverse reactions in the sorafenib group were important factors affecting ICUR. Probabilistic sensitivity analysis showed that tislelizumab had a significant cost-utility advantage when WTP was 3 times GDP, with an economic probability of 81.4%, and the results were robust.

Conclusion For the first-line treatment of advanced unresectable hepatocellular carcinoma, tislelizumab has a significant cost-utility advantage over sorafenib.

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