Background The HEPATORCH trial demonstrated that first-line toripalimab plus bevacizumab (TPB) improves clinical efficacy in patients with unresectable hepatocellular carcinoma (HCC), however its economic implications remain unclear. This study was aimed to assess the cost-effectiveness of TPB compared with sorafenib from the perspective of the Chinese healthcare system. Methods A partitioned survival model was constructed to simulate the long-term economic outcomes for advanced HCC patients. Survival data were derived from the HEPATORCH trial using parametric curve fitting. Direct medical costs and utility values were obtained from local public healthcare databases and literature. The primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) evaluated against China’s willingness-to-pay (WTP) threshold. Model robustness was assessed through one-way sensitivity and probabilistic sensitivity analysis (PSA). Results In the base-case analysis, TPB resulted in an incremental cost of $15,850 and an incremental effectiveness of 0.28 QALYs, leading to an ICER of $57374.33 per QALY, higher than the predefined WTP threshold of $40,334.05 per QALY. Sensitivity analyses identified the duration of treatment bevacizumab(cycle) and cost of bevacizumab per 100 mg as key drivers of model uncertainty. The scenario analysis revealed the varying prices can influence model outcomes and ICER. Conclusion The findings from the analysis suggest that the economic advantage of toripalimab plus bevacizumab in the first-line treatment of advanced HCC is still not achieved in China. Reducing the prices of toripalimab and bevacizumab may improve the cost-effectiveness.