Cost-Effectiveness Analysis of Capecitabine Plus Oxaliplatin Versus Gemcitabine Plus Oxaliplatin as First-Line Therapy for Advanced Biliary Tract Cancers

Abstract

Background: In the first-line treatment of biliary tract cancers (BTCs), XELOX (capecitabine plus oxaliplatin) showed comparable clinical efficacy and safety to gemcitabine and oxaliplatin (GEMOX), with fewer visits and better treatment management. Our study aims to investigate the cost-effectiveness of XELOX and GEMOX as the first-line therapy for BTCs from the perspective of the Chinese healthcare systems and to provide valuable suggestions for clinical decision-making. Methods: A Markov model was developed using the phase 3 randomized clinical trial (ClinicalTrials.gov number, NCT01470443) to evaluate the cost-effectiveness of XELOX and GEMOX. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were used as the primary outcomes of the model. Uncertainty was assessed using univariate and probabilistic sensitivity analysis. Results: The QALYs for the XELOX and GEMOX groups were 0.66 and 0.54, respectively. In China, the total cost of XELOX treatment is US $12,275.51, which is lower than that of the GEMOX regimen. In addition, XELOX is more effective than GEMOX, making it the preferred regimen. A sensitivity analysis determined that XELOX therapy has a stable economic advantage in China. Conclusion: Compared to GEMOX, XELOX is a more cost-effective treatment as a first-line treatment for advanced BTC from the perspective of the Chinese health service system.

Keywords: GEMOX; XELOX; advanced biliary tract cancers; cost-effectiveness; first-line treatment.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Chen, Zhang, Lin, Huang, You, Lai, Wang, Hu and Li.

Figures

FIGURE 1

The Markov state transition model. At the beginning of each Markov cycle, all patients entered the model in the progression-free survival (PFS) with a stable disease state and immediately commenced treatment. From this state, patients could either remain in a PFS state or experience progression and enter progression survival (PS). Patients in the PS could either remain in a PS state or transition to death. PS indicates the progression of the disease.

FIGURE 2

Univariate sensitivity analysis. The tornado plots show the ICER of the XELOX therapy versus the GEMOX therapy for different input parameters in the model. The horizontal axis of the figure represents the range of influence of each element on the results, and the vertical axis shows the name of each uncertainty factor. The horizontal bars indicate the value of the effect of each element on the result and the value of the effect of each element itself. The effects of the factors on the ICER are listed in descending order of significance. Abbreviations: EV, expected value; BSA, body surface area; BSC, best supportive care; PFS, progression-free survival; and PS, progression survival.

FIGURE 3

Probabilistic sensitivity analyses. Dots indicate the results of Monte Carlo simulations, and ellipses indicate 95% confidence intervals. The diagonal line shows WTP. Dots located below the diagonal line indicate cost-effectiveness for the experimental group compared to the corresponding control group. Abbreviations: WTP, willingness to pay. All costs are in United States dollars.

FIGURE 4

Cost-effectiveness acceptability curves (CEACs). The CEAC represents the economic probability of a drug. The curve shows the percentage of cost-effectiveness simulated using different treatment solutions.