First-Line Immunotherapies for Advanced Biliary Tract Cancer: A Systematic Review of Economic Studies
Author(s)
Charlotte Ahmadu, MS1, Tiyi Morris, PhD2, Oliver T. Darlington3.
1Initiate Consultancy Ltd, Aberdeen, United Kingdom, 2Initiate Consultancy, London, United Kingdom, 3Head of HEOR, Initiate Consultancy, NA, United Kingdom.
1Initiate Consultancy Ltd, Aberdeen, United Kingdom, 2Initiate Consultancy, London, United Kingdom, 3Head of HEOR, Initiate Consultancy, NA, United Kingdom.
OBJECTIVES: Biliary tract cancers (BTC) such as cholangiocarcinoma and gallbladder cancer are often identified at an advanced stage, with poor prognoses and ineffective treatments other than curative surgery. Although doublet cisplatin-gemcitabine chemotherapy remains the standard first-line (1L) treatment for unresectable or inoperable BTC, molecular targeted agents have emerged in recent years as efficacious additives to current systemic care. This study aimed to systematically summarise evidence describing the cost-effectiveness of immunotherapies in combination with chemotherapy for patients with advanced BTC, compared to chemotherapy, and identify key drivers.
METHODS: Published economic evaluations up to 01 February 2025 were systematically retrieved from Embase, MEDLINE, EconLit, and the Cochrane Library via Ovid. Secondary searches involved manual checking of conference proceedings, key economic databases and citation tracking. Cost-effectiveness analyses (CEAs) of 1L immunotherapies in advanced BTC were included. Two reviewers independently screened the literature, extracted data, and assessed methodological quality using the Drummond 10-Item rated checklist. The review was registered a priori in PROSPERO (CRD42025644279).
RESULTS: Of the 366 articles identified, 7 CEAs fulfilled the review inclusion criteria; 71% of these studies scored 8 or more points on the Drummond 10-Item checklist. All analyses considered pembrolizumab or durvalumab in combination with cisplatin-gemcitabine chemotherapy as 1L treatment for advanced BTC, using Markov or partitioned survival models and a China, USA, or UK healthcare payer perspective. Immunotherapy was not found to be cost-effective at each country’s willingness-to-pay threshold. The key drivers of cost-effectiveness included cost of treatment, discount rate, and utility of progressed disease and progression-free survival.
CONCLUSIONS: To our knowledge, this is the first published systematic review of CEAs of 1L immunotherapies for advanced BTC. As immune checkpoint inhibitors are not currently cost-effective, evidence-based pricing is important to ensure successful outcomes for pharmaceutical companies, healthcare stakeholders, and patients alike.
METHODS: Published economic evaluations up to 01 February 2025 were systematically retrieved from Embase, MEDLINE, EconLit, and the Cochrane Library via Ovid. Secondary searches involved manual checking of conference proceedings, key economic databases and citation tracking. Cost-effectiveness analyses (CEAs) of 1L immunotherapies in advanced BTC were included. Two reviewers independently screened the literature, extracted data, and assessed methodological quality using the Drummond 10-Item rated checklist. The review was registered a priori in PROSPERO (CRD42025644279).
RESULTS: Of the 366 articles identified, 7 CEAs fulfilled the review inclusion criteria; 71% of these studies scored 8 or more points on the Drummond 10-Item checklist. All analyses considered pembrolizumab or durvalumab in combination with cisplatin-gemcitabine chemotherapy as 1L treatment for advanced BTC, using Markov or partitioned survival models and a China, USA, or UK healthcare payer perspective. Immunotherapy was not found to be cost-effective at each country’s willingness-to-pay threshold. The key drivers of cost-effectiveness included cost of treatment, discount rate, and utility of progressed disease and progression-free survival.
CONCLUSIONS: To our knowledge, this is the first published systematic review of CEAs of 1L immunotherapies for advanced BTC. As immune checkpoint inhibitors are not currently cost-effective, evidence-based pricing is important to ensure successful outcomes for pharmaceutical companies, healthcare stakeholders, and patients alike.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE473
Topic
Economic Evaluation
Disease
Oncology