Comparative Cost-Effectiveness of Gemcitabine and Cisplatin in Combination with S-1, Durvalumab, or Pembrolizumab as First-Line Triple Treatment for Advanced Biliary Tract Cancer.

Publisher: Springer Country of Publication: United States NLM ID: 101479627 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-6636 (Electronic) NLM ISO Abbreviation: J Gastrointest Cancer Subsets: MEDLINE

Publication: 2010- : New York : Springer
Original Publication: New York, NY : Humana Press

Cisplatin*/economics ; Cisplatin*/therapeutic use ; Cisplatin*/administration & dosage ; Cost-Benefit Analysis* ; Antineoplastic Combined Chemotherapy Protocols*/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols*/economics ; Biliary Tract Neoplasms*/drug therapy ; Biliary Tract Neoplasms*/economics ; Biliary Tract Neoplasms*/pathology ; Gemcitabine* ; Antibodies, Monoclonal, Humanized*/economics ; Antibodies, Monoclonal, Humanized*/therapeutic use ; Oxonic Acid*/economics ; Oxonic Acid*/therapeutic use ; Oxonic Acid*/administration & dosage ; Deoxycytidine*/analogs & derivatives ; Deoxycytidine*/economics ; Deoxycytidine*/therapeutic use ; Antibodies, Monoclonal*/economics ; Antibodies, Monoclonal*/therapeutic use ; Tegafur*/economics ; Tegafur*/therapeutic use ; Tegafur*/administration & dosage ; Drug Combinations* ; Quality-Adjusted Life Years*; Humans ; Japan

Purpose: The clinical effectiveness of triple chemotherapy consisting of gemcitabine, cisplatin plus either S-1 (GCS), durvalumab (DGC), or pembrolizumab (PGC) as first-line treatment for advanced biliary tract cancer (BTC) has been reported. However, their comparative cost-effectiveness is unclear. We conducted a model-based cost-effectiveness analysis from the perspective of Japanese healthcare payer.
Methods: A 10-year partitioned survival model was constructed by comparing the time-dependent hazards of the KHBO1401-MITSUBA, TOPAZ-1, and KEYNOTE-966 trials. The cost and utility came from previously published reports. Quality-adjusted life years (QALY) were used to measure the effects on health. Costs for direct medical care were taken into account. There was a one-way analysis and a probability sensitivity analysis. A willingness-to-pay threshold of 7.5 million yen (57,034 USD) per QALY was defined.
Results: The incremental costs per QALY for GCS, DGC, and PGC in the base case study were 3,779,374 JPY (28,740 USD), 86,058,056 JPY (65,4434 USD), and 28,982,059 JPY (220,396 USD), respectively. No parameter had an influence beyond the threshold in a one-way sensitivity analysis. A probabilistic sensitivity analysis revealed that the probability of GCS, DGC, and PGC being cost-effective at the threshold was 85.6%, 0%, and 0%, respectively.
Conclusion: Given the current circumstances, it is probable that triple therapy utilizing GCS will emerge as a plausible and efficient primary chemotherapy strategy for patients with advanced BTC in the Japanese healthcare system, as opposed to DGC and PGC.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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Keywords: Biliary tract cancer; Chemotherapy; Cost-effectiveness; Durvalumab; Pembrolizumab; S-1

Q20Q21Q62J (Cisplatin)
0 (Gemcitabine)
0 (Antibodies, Monoclonal, Humanized)
5VT6420TIG (Oxonic Acid)
0W860991D6 (Deoxycytidine)
150863-82-4 (S 1 (combination))
0 (Antibodies, Monoclonal)
1548R74NSZ (Tegafur)
28X28X9OKV (durvalumab)
DPT0O3T46P (pembrolizumab)
0 (Drug Combinations)

Date Created: 20240822 Date Completed: 20241009 Latest Revision: 20241009

20241009

10.1007/s12029-024-01106-7

39172318