OBJECTIVES: To evaluate the cost-effectiveness of pemigatinib versus mFOLFOX or 5-FU/LV for advanced intrahepatic cholangiocarcinoma (ICC) under Taiwan's 2023 conditional listing price scheme, based on the final results of FIGHT-202 trial published in June 2024.

METHODS: Using data from the ABC-06, the updated NIFTY, and FIGHT-202 trials, we employed two 3-state partitioned survival models to evaluate the cost-effectiveness of pemigatinib versus mFOLFOX and 5-FU/LV over a lifetime horizon of 40 years. The listing price of pemigatinib was NT$12,500 per 13.5 mg; utility, disutility, and other cost parameters were derived from published literature. We used a willingness-to-pay threshold of three times the GDP per capita in 2023 (NT$3,023,055) and applied a 3% discount rate for quality-adjusted life-years (QALYs) and costs. The primary measure was the incremental cost-effectiveness ratio (ICER), with deterministic and probabilistic sensitivity analyses to assess uncertainty. Scenario analysis was conducted to determine the breakeven year.

RESULTS: Compared to mFOLFOX, pemigatinib had incremental QALYs of 1.2, incremental costs of NT$3,107,559, and an ICER of NT$2,595,656 per QALY. Compared to 5-FU/LV, pemigatinib had incremental QALYs of 1.27, incremental costs of NT$3,338,833, and an ICER of NT$2,624,257 per QALY. In the base-case analysis, pemigatinib's ICERs against mFOLFOX and 5-FU/LV were below the threshold, with a 81.4% (mFOLFOX) and 80.1% (5-FU/LV) probability of being cost-effective. The breakeven point was 7.5 years for mFOLFOX and 7.58 years for 5-FU/LV. Primary factors contributing to uncertainty were the medication cost of pemigatinib and health state utilities.

CONCLUSIONS: Based on the latest efficacy data, pemigatinib shows cost-effectiveness over mFOLFOX and 5-FU/LV for Taiwanese patients with advanced ICC and FGFR2 fusions/rearrangements under Taiwan NHI’s conditional listing price.