55Real-world characteristics, costs, and outcomes with best supportive care vs anticancer therapy in patients with advanced BTC
Midhun Malla, Susanne Radke, Mufiza Farid-Kapadia, Julia Ma, Evangelos Chandakas, Lucy Clark, Young JungAbstract
Background & Objectives
Patients with biliary tract cancers (BTCs) have limited therapeutic options and poor prognosis. While immunotherapy combined with gemcitabine and cisplatin is standard of care for late-stage BTC, best supportive care (BSC) remains a viable option. However, research examining characteristics, healthcare costs, and outcomes of patients receiving BSC in the US is limited.
Method
This retrospective, observational study analyzed US-based Optum's de-identified Market Clarity Data (Optum® Market Clarity) of adults diagnosed with late-stage BTC from January 2016-September 2023. The BSC group received no chemotherapy, immunotherapy, targeted, liver-directed, or radiation therapy, or BTC-related surgical resection; the anticancer therapy (ACT) group received ≥1 of the above therapies, excluding resection, on or after initial BTC diagnosis (index date). Baseline characteristics, healthcare costs calculated per patient per month, and overall survival (OS; time from index to death) using Kaplan-Meier methods are reported.
Results
In total, 1576 patients with late-stage BTC were included (BSC, n = 431; ACT, n=l 145). Demographics were similar between groups, however, the BSC group was older, with greater prevalence of cardiovascular disease, diabetes, and more adverse liver function versus the ACT group (Table). During follow-up, patients with available data receiving BSC (n = 288/43 l) incurred higher overall costs than patients receiving ACT (n=ll 11/1145; mean [SD]: $32,257 [$42,085] vs $27,438 [$24,736]), driven by inpatient costs (mean [SD]: $26,387 [$36,753] vs $13,462 [$20,292]). Median (95% CI) OS was 2.2 (2.0-2.4) and 11.4 (10.7-12.6) months (median follow-up: 1.6 vs 8.6 months) for the BSC and ACT groups, respectively.
Conclusion
This is the first comprehensive analysis describing US patients with advanced BTC receiving BSC vs ACT. Patients receiving BSC were older and generally in poorer health, with higher healthcare costs and numerically shorter OS versus patients receiving ACT, highlighting an unmet need for this population, including expanded patient advocacy. Future analysis will identify which patients may benefit from ACT.