# Role of reimbursement and Physicians' awareness in the survival of sorafenib‐eligible advanced hepatocellular carcinoma patients

## TL;DR

This study shows that reimbursement and physician awareness of sorafenib significantly improved survival for patients with advanced liver cancer.

## Contribution

The study demonstrates how drug reimbursement and physician practices impact the real-world effectiveness of sorafenib in hepatocellular carcinoma.

## Key findings

- Patients receiving sorafenib during the reimbursed era had significantly longer survival (8.2 months vs. 4.9 months).
- Longer sorafenib treatment was associated with better survival, especially in patients without tumor rupture.
- Reimbursement and prescription awareness improved clinical outcomes for newly introduced medications in HCC patients.

## Abstract

In 2008, sorafenib became the first approved systemic therapeutic agent for advanced HCC. Although its pharmacological efficacy has been established, reimbursement for such a new, high‐cost drug, as well as physicians' awareness and prescription practice, likewise contribute to its clinical effectiveness. We therefore conducted a retrospective study using 38 sorafenib‐eligible, advanced HCC patients when sorafenib was approved but not yet reimbursed as a control and 216 patients during the reimbursed era. Study group showed longer survival at 8.2 months versus the control's 4.9 months (p = 0.0063 hazard ratio: 0.612 [0.431 ~ 0.868], p = 0.0059). Among the 42 (19.4%) patients who survived more than 2 years, 50% had tumor rupture, and all 32 patients with portal vein tumor thrombus and/or extrahepatic metastasis received sorafenib (p = 0.003). Furthermore, during their first 2 years of HCC management, sorafenib had been given in 29.1% of the treatment courses among survivors between 2 and 5 years while it was prescribed in 55.8% among the more than 5 years survivor group (p < 0.001). In conclusion, survival of sorafenib‐eligible HCC patients significantly improved after reimbursement. Patients who underwent longer sorafenib treatment had a survival advantage, except for those with tumor rupture. Reimbursement and awareness of prescriptions for a newly introduced medication therefore improve clinical effectiveness.