Cost–effectiveness analysis of immune checkpoint inhibitors as first-line therapy in advanced biliary tract cancer

<b>Aim:</b> To assess the cost–effectiveness of immune checkpoint inhibitors as first-line treatments for advanced biliary tract cancer (BTC). <b>Methods:</b> This pharmacoeconomic evaluation employed the fractional polynomial network meta-analysis and partitioned survival model. Costs and utilities were collected from the literature and databases. Sensitivity analyses were used to examine uncertainties. <b>Results:</b> The incremental cost–effectiveness ratios (ICERs) of first-line treatment strategies were $761,371.37 per quality-adjusted life-year (QALY) or $206,222.53/QALY in the US and $354,678.79 /QALY or $213,874.22/QALY in China, respectively. The sensitivity analysis results were largely consistent with the base case. <b>Conclusion:</b> From the US and Chinese payer perspectives, adding durvalumab or pembrolizumab to chemotherapy is unlikely to be cost effective in the first-line setting for advanced BTC. The fractional polynomial network meta-analysis and partitioned survival model technique were employed to assess the cost–effectiveness of first-line immune checkpoint inhibitors for treating advanced biliary tract cancer (BTC) from the standpoint of US and Chinese payers. In comparison to gemcitabine plus cisplatin (GP), pembrolizumab plus GP (PGP) attained an incremental cost–effectiveness ratio (ICER) of $761,371.37/quality-adjusted life-year (QALY) in the US and $354,678.79/QALY in China. The ICER of durvalumab plus GP (DGP) versus PGP was $206,222.53/QALY in the US and $213,874.22/QALY in China. One-way sensitivity analysis (OWSA) yielded an ICER for PGP versus GP from $607,790.88/QALY to $1,011,491.52/QALY and $284,362.14/QALY to $471,195.27/QALY in US and China, respectively. OWSA generated an ICER for DGP versus PGP from $62,539.45/QALY to $349,905.61/QALY and $122,887.67/QALY to $304,860.78/QALY in US and China, respectively. Probabilistic sensitivity analysis (PSA) demonstrated that, when compared with GP in the USA and China, the chances of PGP being cost-effective was 0 and 0% at the threshold of $150,000/QALY and $35,897/QALY, respectively. PGP was preferred to GP in 50% of simulations if the WTP threshold was approximately $754,200/QALY and $350,320/QALY in the USA and China, respectively. PSA showed that, when compared with PGP in the USA and China, the probability of DGP being cost-effective was 0.2704% and 0.0002% at the threshold of $150,000/QALY and $35,897/QALY, respectively. DGP was preferred to PGP in 50% of simulations if the threshold was approximately $203,480/QALY and $211,000/QALY in the USA and China, respectively. From the US and Chinese payer perspectives, adding durvalumab or pembrolizumab to the GP regimen is unlikely to be cost-effective compared with GP in the first-line setting for advanced BTC at the threshold of $150,000/QALY and $35,897/QALY, respectively.