The Cost-Effectiveness of GemCis With or Without Durvalumab in Patients With Advanced CCA

This study examined the costs of treatment with gemcitabine/cisplatin with or without durvalumab in patients with advanced cholangiocarcinoma.

Based on results from TOPAZ-1, which showed that the addition of durvalumab to gemcitabine/cisplatin (GemCis) improved progression-free survival (PFS) and overall survival (OS) compared with GemCis alone, the first-line standard of care for patients with advanced cholangiocarcinoma (CCA) has changed from a chemotherapy-only regimen with GemCis to include the immune checkpoint inhibitor durvalumab. The therapeutic advantage of adding durvalumab to GemCis has been demonstrated; however, the cost of the regimen continues to be an issue. At the 2023 ASCO Gastrointestinal Cancers Symposium, J. Alberto Maldonado, MD, presented results from a cost analysis of GemCis with or without durvalumab.

At the 2023 ASCO Gastrointestinal Cancers Symposium, J. Alberto Maldonado, MD, presented results from a cost analysis of GemCis with or without durvalumab.

Unit prices of durvalumab and GemCis were calculated using the LexiComp, and the drug cost per cycle was calculated for each drug assuming an average patient surface area of 1.9 m² for men and 1.6 m² for women. Excluded costs included cost of administration, adverse events, and follow-up. Similar to the TOPAZ-1 study design, the first 8 cycles included either durvalumab (day 1) plus GemCis (days 1 and 8) or placebo (day 1) plus GemCis (days 1 and 8) every 3 weeks, followed by durvalumab or placebo alone every 4 weeks until disease progression. The sum of all treatment cycles was included as the total treatment cost, and cost per life-year gained was calculated using a combination of total cost per year and treatment duration.

The drug cost per cycle was $13,797 for durvalumab, $282 for gemcitabine, and $87 for cisplatin. The total monthly cost for GemCis alone was $246 compared with $17,492 with the addition of durvalumab, a difference of $17,246. The median PFS in TOPAZ-1 was 7.2 months in the durvalumab group versus 5.7 months in the placebo group, a difference of 1.5 months. The difference in cost between GemCis alone and GemCis plus durvalumab, $17,246, multiplied by PFS months gained, 1.5 months, with the addition of durvalumab resulted in an estimated cost of $25,869 to gain 1.5 months of PFS. Total yearly cost by treatment arm was also higher for the durvalumab plus GemCis group ($209,899 vs $2949).

Although the TOPAZ-1 results were encouraging in terms of PFS and OS benefit, cost-effectiveness evaluation is crucial to address the financial toxicity for CCA patients and indicates a need for further study to investigate cost-effective treatments.

Source:

Maldonado JA, Greten TF, Monge C. Cost-effectiveness of gemcitabine plus cisplatin with and without durvalumab in patients with advanced cholangiocarcinoma. Poster presented at: ASCO Gastrointestinal Cancers Symposium, January 19-21, 2023; San Francisco, CA. Abstract 498.