Cost-effectiveness analysis of durvalumab plus chemotherapy as first-line treatment for biliary tract cancer

Abstract

ObjectiveThe TOPAZ-1 trial reported a significant survival benefit of durvalumab in combination with chemotherapy for the first-line treatment of biliary tract cancer (BTC). However, no studies have evaluated the economics of this treatment option. The aim of this study was to assess the cost effectiveness of durvalumab plus chemotherapy compared to placebo plus chemotherapy from the perspective of US and Chinese payers.MethodsBased on clinical data from the TOPAZ-1 trial, a Markov model was developed to simulate 10-year life expectancy and total healthcare costs for patients with BTC. The treatment group received durvalumab in combination with chemotherapy and the control group received placebo plus chemotherapy. The primary outcomes analyzed included quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainty in the analysis results was assessed by sensitivity analysis.ResultsFor US payers, the placebo plus chemotherapy group had a total cost of $56,157.05 and a utility of 1.10 QALYs, while the durvalumab plus chemotherapy group had a total cost of $217,069.25, a utility of 1.52 QALYs, resulting in an ICER of $381,864.39/QALY. For Chinese payers, the ICER of durvalumab plus chemotherapy group was $367,608.51/QALY. Sensitivity analysis showed that the analysis was most sensitive to the price of durvalumab. For US and Chinese payers, under the respective willing to pay thresholds, the likelihood of the durvalumab plus chemotherapy arm being cost-effective was 0%.ConclusionsBoth in China and in the US, durvalumab in combination with chemotherapy is not a cost-effective option for the first-line treatment of BTC compared with chemotherapy.

Immune checkpoint inhibitor for patients with advanced biliary tract cancer: A cost‐effectiveness analysis

“…18,21 Total costs and health values were discounted at respective rates of 3% and 5% annually in the USA and China. 22…”

“…As details regarding patient QoL or efficacy were not available from the trials used to conduct the present analysis, the PFS and PD states were assigned respective utility values of .76 and .68 based on prior studies focused on aBTC. 22 Grade 3 or higher treatment-associated adverse events (AEs) were assigned a mean disutility value of .073 as a means of assessing deteriorating patient QoL (Table 1). [17][18][19][22][23][24][25] The present study considered direct costs, including the costs of drugs, administration, laboratory testing, imaging, grade 3 or higher AE management (for AEs with ≥5% incidence), BSC and terminal care (Table 1).…”

“…22 Grade 3 or higher treatment-associated adverse events (AEs) were assigned a mean disutility value of .073 as a means of assessing deteriorating patient QoL (Table 1). [17][18][19][22][23][24][25] The present study considered direct costs, including the costs of drugs, administration, laboratory testing, imaging, grade 3 or higher AE management (for AEs with ≥5% incidence), BSC and terminal care (Table 1). Real-world hospital data and information from the Centers for Medicare & Medicaid Services were used to determine drug costs.…”

“…26 While other direct medical costs were derived from prior publications. [17][18][19]22,25,27 Costs were adjusted for inflation to 2023 prices based on the USA consumer price index (CPI). 28 No inflation adjustments were performed for drug pricing in China, as the Chinese government regulates healthcare costs and ensures that they remain stable.…”

“…18 Probabilistic sensitivity analyses were performed through 10 000 repeat samplings of parameters with the Monte Carlo method, and the resultant data were plotted using cost-effectiveness acceptability curves and scatter plots. 22 For this study, six major patient subgroups were analysed. 12,15 Indirect comparisons of the HR values with respect to mOS in different patient subgroups (durvalumab plus GemCis or pembrolizumab plus GemCis versus GemCis) were used to derive the mOS HR values for each cohort (durvalumab plus GemCis versus pembrolizumab plus GemCis).…”