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Cost-Effectiveness of Gemcitabine + Cisplatin vs. Gemcitabine Monotherapy in Advanced Biliary Tract Cancer

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Abstract

Objectives

The ABC-02 trial demonstrated a statistically significant survival benefit associated with the addition of cisplatin to gemcitabine in the palliative treatment of advanced biliary tract cancer (BTC). Based on the ABC-02 findings, this analysis seeks to evaluate the cost-utility of adding cisplatin to standard gemcitabine therapy from a U.S. societal perspective.

Methods

A decision-analytic model was developed to estimate direct medical costs, patient time costs, and quality-adjusted life-years (QALYs) for two treatment strategies: (1) gemcitabine + cisplatin, (2) gemcitabine monotherapy. Model parameters were derived from the pivotal trial of gemcitabine + cisplatin in advanced BTC, published literature, and government sources. The model included trial-based adverse events and costs related to drug treatment, routine follow-up, adverse events, and post-progression care. The model results were examined using one-way and probabilistic sensitivity analyses (PSA).

Results

Total QALYs for the gemcitabine + cisplatin and gemcitabine monotherapy strategies were 0.751 and 0.561, respectively. Total costs were $44,885 and $33,653 respectively. Relative to gemcitabine monotherapy, gemcitabine + cisplatin had an incremental cost-effectiveness ratio (ICER) of $59,480 per QALY gained. One-way sensitivity analyses found results to be sensitive to progression-free survival, overall survival, pre and post-progression health state utility values, and the cost of post-progression care. In the PSA, gemcitabine monotherapy had the highest probability of being cost-effective until a willingness-to-pay of $60,000, after which the gemcitabine + cisplatin strategy had the highest probability.

Conclusion

The results of this analysis suggest that in advanced BTC, the cisplatin + gemcitabine regimen is a cost-effective treatment alternative to gemcitabine monotherapy by currently accepted standards of willingness to pay.

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References

  1. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–82.

    Article  PubMed  CAS  Google Scholar 

  2. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;13:415–23.

    Google Scholar 

  3. Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology. 2001;33:1353–7.

    Article  PubMed  CAS  Google Scholar 

  4. Hopfner M, Schuppan D, Scherubl H. Targeted medical therapy of biliary tract cancer: recent advances and future perspectives. World J Gastroenterol. 2008;14(46):7021–32.

    Article  PubMed  Google Scholar 

  5. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. V.1.2010.

  6. Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Semin Liver Dis. 2004;24:115–25.

    Article  PubMed  Google Scholar 

  7. Zhu AX, El-Khoueiry A, Llovet JM. Accomplishments in 2008 in the management of hepatobiliary cancers. Gastrointest Cancer Res. 2008;3(5):S28–36.

    Google Scholar 

  8. Wolpin BM, Mayer RJ. A step forward in the treatment of advanced biliary tract cancer. N Engl J Med. 2010;362:1335–7.

    Article  PubMed  CAS  Google Scholar 

  9. Glimelius B, Hoffman K, Sjodén PO, et al. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol. 1996;7:593–600.

    Article  PubMed  CAS  Google Scholar 

  10. Thongprasert S. The role of chemotherapy in cholangiocarcinoma. Ann Oncol. 2005;16(2):ii93–6.

    Article  PubMed  Google Scholar 

  11. Capdevila J, Ramos FJ, Macarulla T, Elez E, Ruiz-Echarri M, Perez-Garcia J, et al. Development of new drug strategies in infrequent digestive tumors: esophageal, biliary tract, and anal cancers. Curr Opin Oncol. 2009;21:374–80.

    Article  PubMed  CAS  Google Scholar 

  12. Valle JW, Wasan H, Johnson P, et al. Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomized phase II study: the UK ABC-01 Study. Br J Cancer. 2009;101:621–7.

    Article  PubMed  CAS  Google Scholar 

  13. Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26:3543–51.

    Article  PubMed  CAS  Google Scholar 

  14. Valle JW, Wasan H, Johnson P, Jones E, Dixon L, Swindell R, et al. Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomised phase II study—the UK ABC-01 Study. Br J Cancer. 2009;101:621–7.

    Article  PubMed  CAS  Google Scholar 

  15. Hall FM. Cisplatin plus gemcitabine for biliary tract cancer. N Engl J Med. 2010;363:192–3.

    Article  PubMed  Google Scholar 

  16. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.

    Google Scholar 

  17. Connock M, Round J, Bayliss S, Tubeuf S, Greenheld W, Moore D. Sorafenib for advanced hepatocellular carcinoma: evidence review group report. Health Technol Assess. 2010;14(1):17–21.

    PubMed  Google Scholar 

  18. Yabroff KR, Lamont EB, Mariotto A, Warren JL, Topor M, Meekins A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst. 2008;100:630–41.

    Article  PubMed  Google Scholar 

  19. Stokes ME, Muehlenbein CE, Marciniak MD, Faries DE, Motabar S, Gillespie TW, et al. Neutropenia-related costs in patients treated with first-line chemotherapy for advanced non-small cell lung cancer. J Manage Care Pharm. 2009;15(8):669–82.

    Google Scholar 

  20. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cancer and Chemotherapy-Induced Anemia. V.2.2011.

  21. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prevention and Treatment of Cancer-Related Infections. V.2.2009.

  22. Dobrez D, Cella D, Packard AS, Lai JS, Nickolov A. Estimation of patient preference-based utility weights from the functional assessment of cancer therapy-General. Value Health. 2007;10(4):266–72.

    Article  PubMed  Google Scholar 

  23. Center for Medicare and Medicaid Services. Manufacturer average sales price data. Baltimore: Center for Medicare and Medicaid Services; 2009.

    Google Scholar 

  24. Johns Hopkins Point-of-Care Information Technology Center. Available from: http://www.hopkins-aids.edu/drug/ [Accessed: June 15, 2010].

  25. Center for Medicare and Medicaid Services. Physician free schedule and acute inpatient prospective payment system. Baltimore: Center for Medicare and Medicaid Services; 2009.

    Google Scholar 

  26. Avritscher EBC, Cantor SB, Shih YCT, Escalante CP, Rivera E, Elting LS. Cost-minimization analysis of low-molecular-weight heparin (dalteparin) compared to unfractionated heparin for inpatient treatment of cancer patients with deep venous thrombosis. Support Care Cancer. 2004;12:531–6.

    Article  PubMed  Google Scholar 

  27. U.S. Department of Labor, Bureau of Labor and Statistics. Occupational Employment Statistics. Available from: http://www.bls.gov [Accessed: June 15, 2010].

  28. Ubel PA. What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med. 2003;163:1637–41.

    Article  PubMed  Google Scholar 

  29. Shiroiwa T, Sung YK, Fukuda T, Lang HC, Bae SC, Tsutani K. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness. Health Econ. 2010;19(4):422–37.

    Article  PubMed  Google Scholar 

  30. Glimelius B, Hoffman K, Graf W, Haglund U, Nyrén O, Påhlman L, et al. Cost-effectiveness of palliative chemotherapy in advanced gastrointestinal cancer. Ann Oncol. 1995;6(3):205–7.

    Google Scholar 

  31. Norum J, Angelsen V. Chemotherapy in gastric cancer: an economic evaluation of the FAM (5-fluorouracil, adriamycin, mitomycin C) versus ELF (etoposide, leucovorin, 5-fluorouracil) regimens. J Chemother. 1995;7(5):455–9.

    PubMed  CAS  Google Scholar 

  32. Olaussen KA, Dunant A, Fouret P, Brambilla E, Andre F, Haddad V, et al. DNA repair by ERCC1 in non–small-cell lung cancer and cisplatin-based adjuvant chemotherapy. N Engl J Med. 2006;355(10):983–91.

    Article  PubMed  CAS  Google Scholar 

  33. Cobo M, Isla D, Massuti B, Montes A, Sanchez JM, Provencio M, et al. Customizing cisplatin based on quantitative excision repair cross-complementing 1 mRNA expression: a phase III trial in non–small-cell lung cancer. J Clin Oncol. 2007;25(19):2747–54.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pharmacy, University of Washington, PO Box 357630, Seattle, WA, 98195, USA

    Joshua A. Roth & Josh J. Carlson

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  1. Joshua A. Roth
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Correspondence to Joshua A. Roth.

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Roth, J.A., Carlson, J.J. Cost-Effectiveness of Gemcitabine + Cisplatin vs. Gemcitabine Monotherapy in Advanced Biliary Tract Cancer. J Gastrointest Canc 43, 215–223 (2012). https://doi.org/10.1007/s12029-010-9242-0

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  • DOI: https://doi.org/10.1007/s12029-010-9242-0

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