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Cost-Effectiveness of Durvalumab Plus Gemcitabine and Cisplatin for Patients With Advanced Biliary Tract Cancer
The addition of durvalumab (Durva) to the treatment for patients with advanced biliary tract cancer (cholangiocarcinoma) has been shown to improve progression-free survival (PFS) and overall survival compared to the use of gemcitabine plus cisplatin (Gem/Cis) alone. However, with the addition of Durva there is a significant increase in drug cost for the treatment, according to a study presented at the 2023 ASCO GI Cancers Symposium.
The authors conducted this cost analysis because “the epidemiology of cholangiocarcinoma may indicate [that] some racial and ethnic groups may have a higher incidence and poorer prognosis,” wrote J Alberto Maldonado, MD, National Institutes of Health, Bethesda, MD.
Dr Maldonado and colleagues utilized data from the LexiComp platform to calculate the unit prices of Durva and Gem/Cis. They then calculated the drug cost per cycle for each drug with an average patient surface area of 1.9 m2 for men and 1.6 m2 for women. Since the same vial was used for men and women, the pricing was the same for both. The cost per cycle for Durva, Gem, and Cis was $13,797, $282, and $87, respectively.
The authors followed the TOPAZ-1 study design, so during the first 8 cycles of treatment, patients received Durva or a placebo on day 1 and Gem/Cis on days 1 and 8 of each cycle every 3 weeks. Durva or the placebo were then administered alone every 4 weeks until disease progression.
In the study, the total treatment cost consisted of the sum of all the treatment cycles. The researchers used the total cost per year in each group and treatment duration as the denominator to calculate the cost per life year gained. They did not include administrative costs, adverse effects, and follow-ups in the cost calculations.
The patients who received the regimen with Durva had lengthier treatment duration and PFS (an increase of 1.5 months for each) compared to those who received only Gem/Cis. This difference resulted in an increased cost of $124,170 over the course of treatment, ie, the cost was $127,119 for the regimen with Durva versus $2,949 without Durva. The total yearly cost was also higher for the Durva plus Gem/Cis group compared to Gem/Cis alone ($209,899 and $2,949, respectively).
Although using Durva and Gem/Cis is associated with longer treatment duration and PFS, and does not appear to cause additional toxicity compared to Gem/Cis alone, “Durva plus Gem/Cis was associated with a drug cost over 40 times higher when compared Gem/Cis alone for first-line treatment of advanced biliary tract cancer,” according to the authors.
The study highlights the need for future research to “focus on cost-effective solutions to treat advanced cholangiocarcinoma,” added Maldonado and colleagues.
Source: Maldonado JA, Greten TF, Monge MC. Cost-effectiveness of gemcitabine plus cisplatin with and without durvalumab in patients with advanced cholangiocarcinoma. Presented at: the 2023 ASCO GI Cancers Symposium; January 19-21, 2023; San Francisco, CA, and virtual; Abstract 498.
