Real-World Analysis of Treatment Patterns, Healthcare Utilization, Costs, and Mortality Among People with Biliary Tract Cancers in the USA

Abstract

Introduction: People with advanced biliary tract cancers (BTCs) have a 5-year survival of approximately 2% in the USA. Most cases are inoperable or require systemic treatment following surgery. This study adds to current literature by describing treatment patterns, healthcare resource utilization (HCRU), costs, and mortality among people with BTCs.

Methods: Adults diagnosed with BTCs were identified in the Merative MarketScan administrative claims databases from 1 January 2016 to 30 June 2020. Descriptive analysis was used to measure treatment patterns (i.e., regimen types, therapy duration) during three lines of therapy (LOT). All-cause and disease-related HCRU and costs were measured per-patient-per-month (PPPM) during the entire follow-up and in each LOT. Mortality was reported among the subset linked to the National Death Index (NDI).

Results: There were 2648 eligible people with BTCs [mean age 64.0 (standard deviation [SD] 12.4) years, 51.5% female, average follow-up 11.9 (SD 11.1) months]. Treatment was received by 56.3% (n = 1490), and 20.9% (n = 5534) and 7.1% (n = 187) moved on to a second and third LOT, respectively. The average treatment duration decreased across LOTs, from 3.8 (SD 3.1) months in LOT1 to 2.6 (SD 2.4) months in LOT3. Gemcitabine + cisplatin was the most common regimen in LOT1 (44.6%). Total all-cause mean healthcare costs PPPM increased after LOT1 (mean $21,517, $29,721, and $28,557, for LOT1, LOT2, and LOT3, respectively) and the majority (71.2%) were related to BTCs. Of people with BTCs linked to the NDI (n = 2168), 66.1% died and average time to death was 11.3 (SD 11.2) months.

Conclusions: These findings, showing a high rate of mortality, a decrease in treatment duration, and an increase in costs as people progress after LOT1, add recent data to current literature highlighting the unmet need for more effective treatment options for people with BTCs.

Keywords: Biliary tract cancer; Cost of illness; Healthcare; USA.

Fig. 1

Sample selection of people with BTCs. BTC biliary tract cancer, N number, NDI National Death Index. ^aExtrahepatic BTC site was defined using the following International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes C24.0, C24.8, C24.9. ^bIntrahepatic BTC site was defined using the following ICD-10-CM codes: C22.1, C22.3. ^cGall bladder BTC site was defined using the following ICD-10-CM code: C23

Fig. 2

Regimen distribution by LOT. Data expressed as percentages. BTCs biliary tract cancers, LOT line of therapy ^aFluorouracil, leucovorin, oxaliplatin. ^bFluorouracil, irinotecan, leucovorin, oxaliplatin. ^cFluorouracil, irinotecan, leucovorin

Fig. 3

All-cause and disease-related healthcare expenditures, PPPM. Costs were inflated to 2019 US dollars using the Medical Care Component of the Consumer Price Index. BTCs biliary tract cancers, ER emergency room, LOT line of therapy, PPPM per-patient-per-month

Fig. 4

Kaplan–Meier curve of overall survival measured from BTC index date. BTCs biliary tract cancers, n number

Fig. 5

Kaplan–Meier curve of overall survival measured from start of LOT1. CAPM capecitabine monotherapy, GECP gemcitabine + cisplatin, GEMM gemcitabine monotherapy, LOT line of therapy, n number. ^aFluorouracil, irinotecan, leucovorin. ^bFluorouracil, irinotecan, leucovorin, oxaliplatin