{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:41:40Z","timestamp":1785415300128,"version":"3.56.0"},"reference-count":79,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000921","name":"European Cooperation in Science and Technology","doi-asserted-by":"crossref","award":["CA22125"],"award-info":[{"award-number":["CA22125"]}],"id":[{"id":"10.13039\/501100000921","id-type":"DOI","asserted-by":"crossref"}]},{"award":["CA22125"],"award-info":[{"award-number":["CA22125"]}],"id":[{"id":"https:\/\/ror.org\/01bstzn19","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Biliary tract cancers (BTCs), encompassing cholangiocarcinoma and gallbladder carcinoma, are aggressive malignancies with poor prognosis and increasing incidence in selected regions worldwide. Advances in imaging, biomarker profiling, immunotherapy, and targeted therapies have improved treatment options but have also increased the economic pressure on health systems. Understanding the economic evidence on BTC is therefore important for resource allocation and health technology assessment. Methods: We systematically searched PubMed\/MEDLINE, Embase, Scopus, and Web of Science for peer-reviewed economic studies of BTC published from January 2010 to March 2025. Eligible studies included cost-effectiveness, cost\u2013utility, cost\u2013benefit, cost-of-illness, and resource-use analyses. The review followed PRISMA reporting principles. Reporting completeness was assessed using CHEERS 2022, and methodological credibility was appraised using the Drummond framework. Results: Twenty studies were included: 13 cost-effectiveness or cost\u2013utility analyses and seven cost-of-illness or resource-use studies. Conventional chemotherapy strategies, including gemcitabine plus cisplatin in some settings and other cytotoxic combinations in selected jurisdictions, generally produced more favorable economic results than newer systemic therapies, although findings varied by country, threshold, comparator, and price assumptions. First-line immunotherapy combinations and biomarker-directed targeted therapies frequently produced ICERs above jurisdiction-specific willingness-to-pay thresholds at current prices, often requiring substantial price reductions to approach cost-effectiveness. Real-world studies showed high resource use and costs, particularly with hospitalizations and later treatment lines. Evidence on screening and prevention was limited, with one study suggesting that ultrasound surveillance may be cost-effective in a liver fluke-endemic region of Thailand. Discussion: The available economic evidence suggests that affordability and jurisdiction-specific value assessment are central to BTC policy decisions. Current prices for several immunotherapy and targeted agents limit cost-effectiveness in published models, while evidence on prevention, early detection, and care-pathway interventions remains sparse and context-specific.<\/jats:p>","DOI":"10.3390\/cancers18132057","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:16Z","timestamp":1782366496000},"page":"2057","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic Evidence on Biliary Tract Cancer: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8306-4952","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Rocha-Gomes","sequence":"first","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Pl\u00e1cido da Costa, 4200-450 Porto, Portugal"},{"name":"Ada Health GmbH, 10179 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5555-4148","authenticated-orcid":false,"given":"Ana Sofia","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Department of Informatics Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9741-8476","authenticated-orcid":false,"given":"Marina","family":"Ruiz-Romeo","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, 08035 Barcelona, Spain"},{"name":"ICOnnecta\u2019t Digital Health Program, Catalan Institute of Oncology, Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Psychooncology and Digital Health Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8516-6418","authenticated-orcid":false,"given":"Jos\u00e9 Manuel","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal"},{"name":"Faculty of Economics, University of Porto, 4200-464 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia","family":"Ramos","sequence":"additional","affiliation":[{"name":"Institute for Systems and Computer Engineering, Technology and Science, 4200-465 Porto, Portugal"},{"name":"CEOS.PP, ISCAP, Polytechnic of Porto, 4465-004 S\u00e3o Mamede de Infesta, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.21037\/cco.2016.10.09","article-title":"Biliary tract cancers: Epidemiology, molecular pathogenesis and genetic risk associations","volume":"5","author":"Mohamed","year":"2016","journal-title":"Chin. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Xie, D., Liu, F., Zhou, D., Zhu, Q., Xiao, F., and Zhang, K. (2025). Global burden and cross-country inequalities in gallbladder and biliary tract cancer (1990\u20132021) with projections to 2050: Insights from the Global Burden of Disease Study 2021. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1520714"},{"key":"ref_3","first-page":"99","article-title":"Gallbladder cancer: Epidemiology and outcome","volume":"6","author":"Hundal","year":"2014","journal-title":"Clin. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100569","DOI":"10.1016\/j.lansea.2025.100569","article-title":"Updated cholangiocarcinoma incidence trends and projections in Thailand by region based on data from four population-based cancer registries","volume":"35","author":"Sahat","year":"2025","journal-title":"Lancet Reg. Health Southeast Asia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/jhbp.62","article-title":"Roles of liver fluke infection as risk factor for cholangiocarcinoma","volume":"21","author":"Sithithaworn","year":"2014","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jhep.2019.03.013","article-title":"Global trends in mortality from intrahepatic and extrahepatic cholangiocarcinoma","volume":"71","author":"Bertuccio","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.gastha.2022.04.007","article-title":"Worldwide incidence and mortality of biliary tract cancer","volume":"1","author":"Baria","year":"2022","journal-title":"Gastro Hep Adv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100092","DOI":"10.1016\/j.esmogo.2024.100092","article-title":"New perspectives in biliary tract cancers","volume":"5","author":"Goetze","year":"2024","journal-title":"ESMO Gastrointest. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/liv.14095","article-title":"Cholangiocarcinoma: Epidemiology and risk factors","volume":"39","author":"Khan","year":"2019","journal-title":"Liver Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/jvh.13663","article-title":"Global incidence and mortality of hepatitis B and hepatitis C acute infections, cirrhosis and hepatocellular carcinoma from 2010 to 2019","volume":"29","author":"Veracruz","year":"2022","journal-title":"J. Viral Hepat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"172","DOI":"10.5009\/gnl.2012.6.2.172","article-title":"Epidemiology of gallbladder disease: Cholelithiasis and cancer","volume":"6","author":"Stinton","year":"2012","journal-title":"Gut Liver"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hu, Z., Wang, X., Zhang, X., Sun, W., and Mao, J. (2024). An analysis of the global burden of gallbladder and biliary tract cancer attributable to high BMI in 204 countries and territories: 1990\u20132021. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1521770"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"154848","DOI":"10.1016\/j.metabol.2021.154848","article-title":"Association of prediabetes, diabetes, and diabetes duration with biliary tract cancer risk: A nationwide cohort study","volume":"123","author":"Park","year":"2021","journal-title":"Metabolism"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"379","DOI":"10.2147\/CMAR.S157156","article-title":"Biliary tract cancer: Current challenges and future prospects","volume":"11","author":"Ghidini","year":"2018","journal-title":"Cancer Manag. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Oneda, E., Abu Hilal, M., and Zaniboni, A. (2020). Biliary tract cancer: Current medical treatment strategies. Cancers, 12.","DOI":"10.3390\/cancers12051237"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/liv.14089","article-title":"Surgery for cholangiocarcinoma","volume":"39","author":"Cillo","year":"2019","journal-title":"Liver Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"396","DOI":"10.2214\/AJR.07.2310","article-title":"Preoperative evaluation of bile duct cancer: MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography","volume":"190","author":"Park","year":"2008","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"441","DOI":"10.21873\/cgp.20203","article-title":"Circulating tumor DNA in biliary tract cancer: Current evidence and future perspectives","volume":"17","author":"Rizzo","year":"2020","journal-title":"Cancer Genom. Proteom."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1007\/s00535-020-01712-9","article-title":"Systemic treatment options for advanced biliary tract carcinoma","volume":"55","author":"Xie","year":"2020","journal-title":"J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1080\/14656566.2019.1667335","article-title":"Pharmacotherapeutic options for biliary tract cancer: Current standard of care and new perspectives","volume":"20","author":"Filippi","year":"2019","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1056\/NEJMoa0908721","article-title":"Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer","volume":"362","author":"Valle","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4503","DOI":"10.1200\/jco.2009.27.15_suppl.4503","article-title":"Gemcitabine with or without cisplatin in patients with advanced or metastatic biliary tract cancer (ABC): Results of a multicenter, randomized phase III trial (the UK ABC-02 trial)","volume":"27","author":"Valle","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/S1470-2045(18)30915-X","article-title":"Capecitabine compared with observation in resected biliary tract cancer (BILCAP): A randomised, controlled, multicentre, phase 3 study","volume":"20","author":"Primrose","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102170","DOI":"10.1016\/j.ctrv.2021.102170","article-title":"Targeting FGFR inhibition in cholangiocarcinoma","volume":"95","author":"Goyal","year":"2021","journal-title":"Cancer Treat. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1080\/17474124.2024.2416230","article-title":"Advances in target drugs and immunotherapy for biliary tract cancer","volume":"18","author":"Deiana","year":"2024","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1158\/1078-0432.CCR-22-2036","article-title":"FDA approval summary: Pemigatinib for previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with FGFR2 fusion or other rearrangement","volume":"29","author":"Patel","year":"2023","journal-title":"Clin. Cancer Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/S1470-2045(20)30157-1","article-title":"Ivosidenib in IDH1-mutant, chemotherapy-refractory cholangiocarcinoma (ClarIDHy): A multicentre, randomised, double-blind, placebo-controlled, phase 3 study","volume":"21","author":"Macarulla","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/S2468-1253(24)00095-5","article-title":"Durvalumab or placebo plus gemcitabine and cisplatin in participants with advanced biliary tract cancer (TOPAZ-1): Updated overall survival from a randomised phase 3 study","volume":"9","author":"Oh","year":"2024","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1016\/S0140-6736(23)00727-4","article-title":"Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): A randomised, double-blind, placebo-controlled, phase 3 trial","volume":"401","author":"Kelley","year":"2023","journal-title":"Lancet"},{"key":"ref_30","unstructured":"Greenhalgh, J., Mahon, J., Bryning, S., Chaplin, M., Beale, S., Boland, A., Dundar, Y., McEntee, J., and Basu, B. (2023). Durvalumab with Gemcitabine and Cisplatin for Treating Unresectable or Advanced Biliary Tract Cancer [ID4031], Liverpool Reviews and Implementation Group, University of Liverpool."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1038\/s41575-020-0310-z","article-title":"Cholangiocarcinoma 2020: The next horizon in mechanisms and management","volume":"17","author":"Banales","year":"2020","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.5009\/gnl.2010.4.S1.S62","article-title":"Photodynamic therapy for cholangiocarcinoma","volume":"4","author":"Talreja","year":"2010","journal-title":"Gut Liver"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2217\/hep.13.9","article-title":"Current state of nonsurgical therapies for cholangiocarcinoma","volume":"1","author":"Brass","year":"2014","journal-title":"Hepatic Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.3748\/wjg.v29.i13.1969","article-title":"Liver transplantation in the management of cholangiocarcinoma: Evolution and contemporary advances","volume":"29","author":"Borakati","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Schaft, N., Dorrie, J., Schuler, G., Schuler-Thurner, B., Sallam, H., Klein, S., Eisenberg, G., Frankenburg, S., Lotem, M., and Khatib, A. (2023). The future of affordable cancer immunotherapy. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1248867"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jval.2017.12.018","article-title":"Affordability challenges to value-based pricing: Mass diseases, orphan diseases, and cures","volume":"21","author":"Danzon","year":"2018","journal-title":"Value Health"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ye, Z.-M., Xu, Z., Li, H., and Li, Q. (2023). Cost-effectiveness analysis of durvalumab plus chemotherapy as first-line treatment for biliary tract cancer. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1046424"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Reimbursement Team (2022). Pemigatinib (Pemazyre). Can. J. Health Technol., 2, 1\u201325.","DOI":"10.51731\/cjht.2022.303"},{"key":"ref_39","unstructured":"NICE (2021). Pemigatinib for Treating Relapsed or Refractory Advanced Cholangiocarcinoma with FGFR2 Fusion or Rearrangement, National Institute for Health and Care Excellence."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e067975","DOI":"10.1136\/bmj-2021-067975","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations","volume":"376","author":"Husereau","year":"2022","journal-title":"BMJ"},{"key":"ref_42","unstructured":"Drummond, M.F., Sculpher, M.J., Claxton, K., Stoddart, G.L., and Torrance, G.W. (2015). Methods for the Economic Evaluation of Health Care Programmes, Oxford University Press. [4th ed.]."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"658","DOI":"10.21037\/jgo-20-544","article-title":"Burden of illness for patients with cholangiocarcinoma in the United States: A retrospective claims analysis","volume":"12","author":"Chamberlain","year":"2021","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Chen, R., Zhang, Y., Lin, K., Huang, D., You, M., Lai, Y., Wang, J., Hu, Y., and Li, N. (2022). Cost-effectiveness analysis of capecitabine plus oxaliplatin versus gemcitabine plus oxaliplatin as first-line therapy for advanced biliary tract cancers. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.871262"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Chen, K.A., Huang, W.M., Chen, E.Y.T., Ho, P.K., Chueh, C.H., Wen, Y.W., Chen, M.H., Chiang, N.J., and Tsai, Y.W. (2024). Cost-effectiveness of ivosidenib versus chemotherapy for previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma in Taiwan. BMC Cancer, 24.","DOI":"10.1186\/s12885-024-12362-y"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1002\/cncr.35249","article-title":"Characterizing the burden of biliary tract cancers across 28 hospitals in Ontario, Canada","volume":"130","author":"Choi","year":"2024","journal-title":"Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s40273-022-01227-6","article-title":"Cost-effectiveness analysis of a new second-line treatment regimen for advanced intrahepatic cholangiocarcinoma: Biomarker-driven targeted therapy of pemigatinib versus 5-FU chemotherapy","volume":"41","author":"Chueh","year":"2023","journal-title":"PharmacoEconomics"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1080\/14737167.2021.1842201","article-title":"Analysis of hospital incidence and direct medical costs of intrahepatic cholangiocarcinoma in Spain (2000\u20132018)","volume":"21","year":"2021","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e094047","DOI":"10.1136\/bmjopen-2024-094047","article-title":"Cost-effectiveness analysis of pembrolizumab plus chemotherapy as first-line treatment for advanced biliary tract cancer: Perspectives from US and Chinese payers","volume":"15","author":"Jiang","year":"2025","journal-title":"BMJ Open"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/s12029-024-01106-7","article-title":"Comparative Cost-Effectiveness of Gemcitabine and Cisplatin in Combination with S-1, Durvalumab, or Pembrolizumab as First-Line Triple Treatment for Advanced Biliary Tract Cancer","volume":"55","author":"Kashiwa","year":"2024","journal-title":"J. Gastrointest. Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"4117","DOI":"10.31557\/APJCP.2023.24.12.4117","article-title":"Cost-effectiveness analysis of ultrasound surveillance for cholangiocarcinoma in an endemic area of Thailand","volume":"24","author":"Laopachee","year":"2023","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1002\/bjs5.50325","article-title":"Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease","volume":"4","author":"Lundgren","year":"2020","journal-title":"BJS Open"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Luo, X., Cai, T., Wu, J., Li, X., Wang, X., and Ma, H. (2024). Cost-effectiveness of pembrolizumab plus chemotherapy vs. chemotherapy as first-line treatment for advanced biliary tract cancer in China and the US. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1393559"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1007\/s00268-018-4619-5","article-title":"Routine pathology and postoperative follow-up are not cost-effective in cholecystectomy for benign gallbladder disease","volume":"42","author":"Olthof","year":"2018","journal-title":"World J. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1080\/13696998.2023.2187604","article-title":"Productivity loss outcomes and costs among patients with cholangiocarcinoma in the United States: An economic evaluation","volume":"26","author":"Parasuraman","year":"2023","journal-title":"J. Med. Econ."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s12029-010-9242-0","article-title":"Cost-effectiveness of gemcitabine + cisplatin vs. gemcitabine monotherapy in advanced biliary tract cancer","volume":"43","author":"Roth","year":"2012","journal-title":"J. Gastrointest. Cancer"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1007\/s12029-016-9885-6","article-title":"A cost-effectiveness analysis of gemcitabine plus cisplatin versus gemcitabine alone for treatment of advanced biliary tract cancer in Japan","volume":"48","author":"Tsukiyama","year":"2017","journal-title":"J. Gastrointest. Cancer"},{"key":"ref_58","first-page":"213","article-title":"Healthcare utilization and costs associated with cholangiocarcinoma","volume":"5","author":"Wadhwa","year":"2017","journal-title":"Gastroenterol. Rep."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1080\/14796694.2024.2379237","article-title":"Real-world treatment patterns, resource utilization and costs in biliary tract cancers in the USA","volume":"20","author":"Wang","year":"2024","journal-title":"Future Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12962-023-00429-9","article-title":"Cost-effectiveness analysis of adding durvalumab to chemotherapy as first-line treatment for advanced biliary tract cancer based on the TOPAZ-1 trial","volume":"21","author":"Zhao","year":"2023","journal-title":"Cost Eff. Resour. Alloc."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Zheng, Z., Fang, L., and Cai, H. (2023). Cost-effectiveness analysis of pembrolizumab in combination with chemotherapy compared with chemotherapy alone as first-line treatment for patients with advanced biliary tract cancer in China. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11255-w"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1001\/jamaoncol.2021.3836","article-title":"Final overall survival efficacy results of ivosidenib for patients with advanced cholangiocarcinoma with IDH1 mutation: The phase 3 randomized clinical ClarIDHy trial","volume":"7","author":"Zhu","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/S1470-2045(21)00027-9","article-title":"Second-line FOLFOX chemotherapy versus active symptom control for advanced biliary tract cancer (ABC-06): A phase 3, open-label, randomised, controlled trial","volume":"22","author":"Lamarca","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"100055","DOI":"10.1016\/j.esmogo.2024.100055","article-title":"Second-line FOLFOX chemotherapy for patients with advanced biliary tract cancers pretreated with cisplatin\/gemcitabine: A systematic review and meta-analysis","volume":"4","author":"Digklia","year":"2024","journal-title":"ESMO Gastrointest. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e153","DOI":"10.1097\/MCG.0000000000001524","article-title":"Photodynamic therapy (PDT), radiofrequency ablation (RFA) with biliary stents in palliative treatment of unresectable extrahepatic cholangiocarcinoma: A systematic review and meta-analysis","volume":"56","author":"Mohan","year":"2022","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Aebisher, D., Rogoz, K., Mysliwiec, A., Dynarowicz, K., Wiench, R., Cieslar, G., Kawczyk-Krupka, A., and Bartusik-Aebisher, D. (2024). The use of photodynamic therapy in medical practice. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1373263"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Khuntikeo, N., Chamadol, N., Yongvanit, P., Loilome, W., Namwat, N., Sithithaworn, P., Andrews, R.H., Petney, T.N., Promthet, S., and Thinkhamrop, K. (2015). Cohort profile: Cholangiocarcinoma screening and care program (CASCAP). BMC Cancer, 15.","DOI":"10.1186\/s12885-015-1475-7"},{"key":"ref_68","first-page":"1367","article-title":"Liver fluke prevention and control in the northeast of Thailand through action research","volume":"12","author":"Wongba","year":"2011","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Hunter, L.A., and Soares, H.P. (2021). Quality of life and symptom management in advanced biliary tract cancers. Cancers, 13.","DOI":"10.3390\/cancers13205074"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1016\/j.jval.2020.04.1772","article-title":"Health state utility values across cancer types and stages: A systematic literature review","volume":"23","author":"Pourrahmat","year":"2020","journal-title":"Value Health"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s11523-024-01086-5","article-title":"The epidemiology of biliary tract cancer and associated prevalence of MDM2 amplification: A targeted literature review","volume":"19","author":"Kratz","year":"2024","journal-title":"Target. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Zeng, Z., Zeng, J., Liu, C., Qiu, J., Li, Y., Tang, J., Mo, N., Du, L., and Ma, J. (2021). Efficacy and safety of first-line chemotherapies for patients with advanced biliary tract carcinoma: A systematic review and network meta-analysis. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.736113"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"798","DOI":"10.5009\/gnl210346","article-title":"Real-world outcomes of gemcitabine, cisplatin, and nab-paclitaxel chemotherapy regimen for advanced biliary tract cancer: A propensity score-matched analysis","volume":"16","author":"Jung","year":"2022","journal-title":"Gut Liver"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1002\/bjs.10962","article-title":"Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver","volume":"106","author":"Bjornelv","year":"2019","journal-title":"Br. J. Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.3390\/curroncol31050184","article-title":"New anticancer drugs: Reliably assessing \u201cvalue\u201d while addressing high prices","volume":"31","author":"Stewart","year":"2024","journal-title":"Curr. Oncol."},{"key":"ref_76","unstructured":"World Bank (2026, June 12). World Development Indicators: Consumer Price Index (FP.CPI.TOTL). Available online: https:\/\/data.worldbank.org\/indicator\/FP.CPI.TOTL."},{"key":"ref_77","unstructured":"Board of Governors of the Federal Reserve System (2026, June 12). Foreign Exchange Rates: G.5A Annual Release, Available online: https:\/\/www.federalreserve.gov\/releases\/g5a\/current\/."},{"key":"ref_78","unstructured":"Directorate-General of Budget, Accounting and Statistics, Executive Yuan, Taiwan (2026, June 12). Consumer Price Index, Available online: https:\/\/eng.dgbas.gov.tw\/."},{"key":"ref_79","unstructured":"Bank of Thailand, and Ministry of Commerce, Thailand (2026, June 12). Headline Consumer Price Index Annual Change. Available online: https:\/\/www.bot.or.th\/."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2057\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:00:44Z","timestamp":1782536444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":79,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["cancers18132057"],"URL":"https:\/\/doi.org\/10.3390\/cancers18132057","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]}}}