ECONOMIC BURDEN AND COST EFFECTIVENESS OF ADVANCED GALLBLADDER CANCER TREATMENT IN NORTHEAST INDIA: A DUAL PHASE ASSESSMENT
Author(s)
Christy Thomas1, Krishna Undela, PhD2, vismitha varghese, Other3;
1NIPER Guwahati Assam, Research Scholar, Changsari, India, 2NIPER Guwahati Assam, Guwahati, India, 3NIPER, GUWAHATI, India
1NIPER Guwahati Assam, Research Scholar, Changsari, India, 2NIPER Guwahati Assam, Guwahati, India, 3NIPER, GUWAHATI, India
OBJECTIVES: Gallbladder cancer (GBC) imposes a disproportionately high burden in Northeast India, yet evidence on its societal-economic impact and value for money of available treatments remains limited. We aim to quantify productivity losses due to premature GBC mortality and to evaluate the cost-effectiveness of standard treatment strategies for advanced GBC.
METHODS: A dual-phase approach was adopted. Phase-I was a hospital-based observational study estimating productivity losses and disability-adjusted life years (DALYs) among GBC patients using human capital approach. Years of potential productive life lost (YPPLL) were monetized, and DALYs were calculated using years of life lost and years lived with disability using disability weights. Phase-II employed a decision-analytic Markov model to compare best supportive care (BSC), gemcitabine monotherapy (Gem), and gemcitabine plus cisplatin (Gem+Cis) over a lifetime horizon with 3-month cycles from the Government of India payer perspective. Transition probabilities were derived from the ABC-02 trial; costs (2025 INR) and utilities were based on Indian sources. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were estimated using a willingness-to-pay (WTP) threshold of ₹185,000/QALY. One-way sensitivity analysis examined uncertainty in progression probabilities.
RESULTS: Among 61 premature GBC deaths, cumulative YPPLL was 994.2 years and total DALYs were 1,006.5, corresponding to productivity losses of USD 1.33 million. Younger age at onset was the strongest determinant of economic burden (p<0.001), while gender and stage showed no significant differences. In Phase II, Gem+Cis generated the highest health gains (1.76 QALYs) and NMB (₹249,238), with ICERs of ₹28,657/QALY for Gem and ₹43,386/QALY for Gem+Cis versus BSC, both well below the WTP threshold. Gem+Cis remained the preferred strategy across extensive sensitivity analyses.
CONCLUSIONS: Advanced GBC in Northeast India results in substantial productivity losses due to premature mortality. Gemcitabine plus cisplatin represents a cost-effective and economically efficient treatment option, supporting its prioritization in regional oncology practice and health policy decision-making.
METHODS: A dual-phase approach was adopted. Phase-I was a hospital-based observational study estimating productivity losses and disability-adjusted life years (DALYs) among GBC patients using human capital approach. Years of potential productive life lost (YPPLL) were monetized, and DALYs were calculated using years of life lost and years lived with disability using disability weights. Phase-II employed a decision-analytic Markov model to compare best supportive care (BSC), gemcitabine monotherapy (Gem), and gemcitabine plus cisplatin (Gem+Cis) over a lifetime horizon with 3-month cycles from the Government of India payer perspective. Transition probabilities were derived from the ABC-02 trial; costs (2025 INR) and utilities were based on Indian sources. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs) were estimated using a willingness-to-pay (WTP) threshold of ₹185,000/QALY. One-way sensitivity analysis examined uncertainty in progression probabilities.
RESULTS: Among 61 premature GBC deaths, cumulative YPPLL was 994.2 years and total DALYs were 1,006.5, corresponding to productivity losses of USD 1.33 million. Younger age at onset was the strongest determinant of economic burden (p<0.001), while gender and stage showed no significant differences. In Phase II, Gem+Cis generated the highest health gains (1.76 QALYs) and NMB (₹249,238), with ICERs of ₹28,657/QALY for Gem and ₹43,386/QALY for Gem+Cis versus BSC, both well below the WTP threshold. Gem+Cis remained the preferred strategy across extensive sensitivity analyses.
CONCLUSIONS: Advanced GBC in Northeast India results in substantial productivity losses due to premature mortality. Gemcitabine plus cisplatin represents a cost-effective and economically efficient treatment option, supporting its prioritization in regional oncology practice and health policy decision-making.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH97
Topic
Epidemiology & Public Health
Disease
SDC: Gastrointestinal Disorders, SDC: Oncology