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Advanced Biliary Tract Cancer: Is Durvalumab Plus Chemotherapy a Cost-Effective Treatment in China?

By: Joshua Swore, PhD
Posted: Monday, May 22, 2023

The addition of the monoclonal antibody durvalumab to the chemotherapy agents gemcitabine and cisplatin for the treatment of advanced biliary tract cancer is not cost-effective, even with charitable assistance, according to an article published in the journal Cost Effectiveness and Resource Allocation. “The TOPAZ-1 study demonstrated a survival advantage and better tolerability for durvalumab, but durvalumab is dramatically expensive for patients,” said Yang et al, of Fujan Medical University, Fuzhou, China. “Therefore, we aimed to evaluate the cost-effectiveness of durvalumab plus chemotherapy for advanced [biliary tract cancer] from the perspective of the Chinese health-care system and provide a reference for optimizing the allocation of limited medical resources for clinicians and decision-makers.”

The authors used a three-state Markov model to estimate the total costs, quality-adjusted life years, and used incremental cost-effectiveness ratio as an evaluation index. The willingness to pay threshold was established using the triple 2021 Chinese per capita gross domestic product of $37,663.26 per quality-adjusted life years. To test model robustness, the authors used both one-way and probabilistic sensitivity analyses.

Results indicated that the incremental cost-effectiveness ratio for durvalumab plus chemotherapy was $159,644.70 per quality-adjusted life years with charity assistance and $696,571.11 per quality-adjusted life years without charity assistance, both exceeding the established willingness to pay threshold. The authors then explored what it would take for durvalumab plus chemotherapy to become cost-effective using the three-state Markov model; they found that it became economical only when the price of durvalumab was decreased by more than 94.2% to less than $0.33/mg. Furthermore, the model established that the cost of durvalumab had the greatest influence on the incremental cost-effectiveness ratio and that it was impossible to be cost-effective at the willingness-to-pay threshold, in this patient population.

Disclosure: The study authors reported no conflicts of interest.

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