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

Abstract

Background and AimsThe increasingly widespread of immune checkpoint inhibitors (ICIs) in the field of antitumors has brought a new dawn for patients with advanced biliary tract cancer (aBTC). However, the choice of treatment needs to be supported by economic evaluation. Therefore, the cost‐effectiveness comparison of first‐line durvalumab or pembrolizumab plus gemcitabine and cisplatin (GemCis) treatment of aBTC was explored from the perspective of American and Chinese healthcare systems.MethodsGround on the TOPAZ‐1 and KEYNOTE‐966 trials, the Markov model with a 15‐year horizon including three health states to imitate cost and effective outcomes was established. Incremental cost‐effectiveness ratio (ICER) at willingness‐to‐pay (WTP) thresholds of $100 000/QALY and $37 408/ALY in the USA and China was used as the most important indicator. Other endpoint indexes included total cost, life years (LYs), quality‐adjusted life years (QALYs) and incremental net‐health benefit (INHB). To verify the robustness, sensitivity and subgroup analyses were performed.ResultsDurvalumab plus GemCis ($322 211 [2.94 QALYs] and $35 695 [2.76 QALYs]) increased cost (effectiveness) by $63 777 (.22 QALYs) and $5234 (.20 QALYs) than pembrolizumab plus GemCis ($258 434 [2.72 QALYs] and $30 461 [2.56 QALYs]) in the USA and China, respectively. The corresponding ICER was $288 725/QALY and $26 401/QALY, with INHB of −.42 and .06 QALYs, respectively. The cost of ICIs was the most important factor influencing results.ConclusionsIn China, first‐line durvalumab plus GemCis versus pembrolizumab plus GemCis was a cost‐effective option for patients with aBTC, but not in the USA.

Evaluation of Overall Survival by Restricted Mean Survival Time of Advanced Biliary Tract Cancer treated with Immunotherapy: A Systematic Review and Meta-Analysis

“…These considerations are not trivial, and in some cases, the time lost in receiving certain treatment regimens should be balanced with the survival gains offered by treatment [31]. Similarly, the contradictory results of different cost-effectiveness analyses further reinforce the potential benefits of assessing clinical benefits in absolute terms, as offered by RMST [32][33][34][35][36][37].…”