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Lirafugratinib (Lyrfigtu)

Previously treated FGFR2 fusion or rearrangement-positive cholangiocarcinoma

Also known as RLY-4008
Last updated
158 sources

Cost-effectiveness analyses and utility weights

Published cost-effectiveness analyses and health-state utility weights that a model of this product could cite, adapt, or compare against, grouped by how each article relates to the product and its indication. Every value is quoted from the article it cites, and section 3 lists the searches that found the articles.

11 cost-effectiveness analyses and 10 studies reporting utility weights · 12 sources

Overview

ItemDetail
Literature searchedTufts Medical Center Cost-Effectiveness Analysis Registry, searched October 21, 2026; the queries are listed in section 3.
Cost-effectiveness analyses11
Studies reporting utility weights10

Cost-effectiveness analyses

Analyses of Lirafugratinib (Lyrfigtu and RLY-4008)

No evidence found.

Treatments for the same indication

Pemigatinib versus mFOLFOX with active symptom control and versus active symptom control alone in relapsed or refractory FGFR2 fusion-positive cholangiocarcinoma, England: NICE TA722 committee discussion (2021)

Relevance: Evaluates pemigatinib, a reversible FGFR inhibitor listed in section 2, against mFOLFOX with active symptom control and against active symptom control alone in relapsed or refractory FGFR2 fusion-positive cholangiocarcinoma in a NICE technology appraisal for England.

“The company's partitioned survival model used parametric survival models to predict outcomes including time-on-treatment, progression-free survival and overall survival. The model included people in both the progression-free and post-progression health states, either on or off treatment.” (opens the source at this quote in a new tab)

“It used a life-time horizon with a cycle length of 1 week. An annual discount rate of 3.5% was applied to costs and outcomes.” (opens the source at this quote in a new tab)

“The committee noted that the company's new base-case ICERs for pemigatinib, including an updated patient access scheme, were £42,076 per QALY gained compared with mFOLFOX+ASC, and £45,029 per QALY gained compared with ASC alone.” (opens the source at this quote in a new tab)

“Using these preferred assumptions, the ICER was between £45,051 and £45,808 per QALY gained compared with mFOLFOX+ASC, and between £44,354 and £45,010 per QALY gained compared with ASC alone.” (opens the source at this quote in a new tab)

“For a life-extending treatment at the end of life, the upper limit of the range usually considered to represent a cost-effective use of NHS resources is £50,000 per quality-adjusted life year (QALY) gained.” (opens the source at this quote in a new tab)

“It concluded that the cost-effectiveness estimates for pemigatinib suggest it is an acceptable use of NHS resources for a life-extending treatment at the end of life. So pemigatinib was recommended for routine use in the NHS.” (opens the source at this quote in a new tab)

Pemigatinib versus mFOLFOX and versus fluorouracil in previously treated FGFR2 fusion-positive advanced intrahepatic cholangiocarcinoma, Taiwan: Chen et al. (2023)

Relevance: Evaluates second-line pemigatinib, a reversible FGFR inhibitor listed in section 2, against mFOLFOX and against fluorouracil chemotherapy in FGFR2 fusion-positive advanced intrahepatic cholangiocarcinoma from the perspective of Taiwan's National Health Insurance Administration.

“This study aims to analyze the cost-effectiveness of pemigatinib 13.5 mg as a second-line treatment compared to mFOLFOX and 5-FU chemotherapy for advanced ICC patients with FGFR2 fusions/rearrangements from the perspective of Taiwan’s NHIA.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“This study used a 3-state partitioned survival model to analyze the 5 year cost-effectiveness of pemigatinib as a second-line treatment for advanced ICC patients in whom first-line gemcitabine-based chemotherapy failed and to compare the results with those for the mFOLFOX and 5-FU chemotherapy regimens.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“An annual discount of 3% was applied to health outcomes and costs.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Costs listed in 2022 Taiwan dollars” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Pemigatinib was associated with a 0.59 QALY increase with incremental costs of NT$3,428,442 and a 0.68 QALY increase with incremental costs of NT$3,653,100, yielding an ICER of NT$5,814,700 per QALY and an ICER of NT$5,380,241 per QALY compared to mFOLFOX and 5-FU, respectively” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“pemigatinib was more effective but more expensive, resulting in a 6.5% and 4.6% probability of being cost-effective under a WTP threshold of 3 times the GDP per capita per QALY gained.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“When the medication cost of pemigatinib was reduced by more than 50%, pemigatinib gained a positive INMB of NT$55,374 and NT$92,437, with a probability of 72.0% and 77.1% of being cost-effective, respectively” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Biomarker-driven pemigatinib or mFOLFOX versus fluorouracil chemotherapy in previously treated advanced intrahepatic cholangiocarcinoma, Taiwan: Chueh et al. (2023)

Relevance: Evaluates second-line treatment selected by FGFR2 status, pemigatinib or mFOLFOX, against fluorouracil chemotherapy in advanced intrahepatic cholangiocarcinoma in Taiwan, with pemigatinib a reversible FGFR inhibitor listed in section 2.

“This cost-effectiveness analysis evaluated the cost-effectiveness of the pemigatinib/mFOLFOX regimen as the second-line treatment for advanced intrahepatic cholangiocarcinoma based on FGFR2 status in comparison with the regimen of fluorouracil chemotherapy and provided a cost-effectiveness analysis-based reference price for pemigatinib.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“A three-state partitioned survival model with a 5-year time horizon was constructed for patients with advanced intrahepatic cholangiocarcinoma who did not respond to first-line therapy.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The willingness-to-pay threshold was three times the gross domestic product per capita in 2021 (NT$2,889,684). A 3% discount rate was applied to quality-adjusted life-years and costs.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The new regimen provided an incremental 0.13 quality-adjusted life-years, with incremental costs of NT$459,697, yielding an incremental cost-effectiveness ratio of NT$3,411,098 per quality-adjusted life-year and an incremental net monetary benefit of - NT$70,268.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The new regimen was found to be 53.2% cost effective in the probabilistic sensitivity analysis.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“In scenario analyses, the incremental net monetary benefit was positive when the price of pemigatinib was reduced by 40% or more.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

The same disease in other populations or settings

Ivosidenib versus mFOLFOX and versus fluorouracil with leucovorin in previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma, Taiwan: Chen et al. (2024a)

Relevance: Evaluates ivosidenib against chemotherapy in previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma in Taiwan, the same line of therapy in another molecularly selected subgroup.

“we aimed to assess ivosidenib’s cost-effectiveness in previously treated, advanced ICC-presenting IDH1 mutations compared with mFOLFOX or 5-FU/LV.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“A 3-state partitioned survival model was employed to assess ivosidenib’s cost-effectiveness over a 10-year horizon with a 3% discount rate, setting the willingness-to-pay threshold at 3 times the 2022 GDP per capita.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“All analyses were conducted from the perspective of Taiwan NHIA.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Compared with mFOLFOX, ivosidenib yielded an incremental gain of 0.37 QALY at an incremental cost of NT$2,346,032. This resulted in an ICER of NT$6,268,528 per QALY and an INMB of NT$ − 1,251,116.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In comparison with the 5-FU/LV regimen, ivosidenib provided an incremental benefit of 0.44 QALY, incurring an incremental cost of NT$2,478,942 and resulting in an ICER of NT$5,670,555 per QALY and an associated INMB of NT$ − 1,199,993.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“At NT$10,402/500 mg, ivosidenib was not cost-effective for IDH1 -mutant ICC patients compared with mFOLFOX or 5-FU/LV, indicating that a 50–60% price reduction is necessary for ivosidenib to be cost-effective in this patient group.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Durvalumab versus pembrolizumab, each with gemcitabine and cisplatin, in first-line advanced biliary tract cancer, United States and China: Zhu et al. (2023)

Relevance: Compares durvalumab and pembrolizumab, each given with gemcitabine and cisplatin, as first-line treatment of advanced biliary tract cancer from United States and Chinese healthcare system perspectives, the first-line chemoimmunotherapy section 2 lists before the previously treated setting of the report.

Access: Free full text

“the cost-effectiveness comparison of first-line durvalumab or pembrolizumab plus gemcitabine and cisplatin (GemCis) treatment of aBTC was explored from the perspective of American and Chinese healthcare systems.” (opens the source at this quote in a new tab)

“Ground on the TOPAZ-1 and KEYNOTE-966 trials, the Markov model with a 15-year horizon including three health states to imitate cost and effective outcomes was established.” (opens the source at this quote in a new tab)

“Total costs and health values were discounted at respective rates of 3% and 5% annually in the USA and China.” (opens the source at this quote in a new tab)

“Incremental cost-effectiveness ratio (ICER) at willingness-to-pay (WTP) thresholds of $100 000/QALY and $37 408/ALY in the USA and China was used as the most important indicator.” (opens the source at this quote in a new tab)

“Durvalumab plus GemCis ($322 211 [2.94 QALYs] and $35 695 [2.76 QALYs]) increased cost (effectiveness) by $63 777 (.22 QALYs) and $5234 (.20 QALYs) than pembrolizumab plus GemCis ($258 434 [2.72 QALYs] and $30 461 [2.56 QALYs]) in the USA and China, respectively.” (opens the source at this quote in a new tab)

“The corresponding ICER was $288 725/QALY and $26 401/QALY, with INHB of −.42 and .06 QALYs, respectively.” (opens the source at this quote in a new tab)

“In China, first-line durvalumab plus GemCis versus pembrolizumab plus GemCis was a cost-effective option for patients with aBTC, but not in the USA.” (opens the source at this quote in a new tab)

Durvalumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin in first-line advanced biliary tract cancer, United States and China: Ye et al. (2023)

Relevance: Evaluates durvalumab added to gemcitabine and cisplatin, the TOPAZ-1 regimen listed in section 2 as first-line treatment, against gemcitabine and cisplatin in advanced biliary tract cancer in the United States and China.

“The aim of this study was to assess the cost effectiveness of durvalumab plus chemotherapy compared to placebo plus chemotherapy from the perspective of US and Chinese payers.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Based on clinical data from the TOPAZ-1 trial, a Markov model was developed to simulate 10-year life expectancy and total healthcare costs for patients with BTC.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“This research was based on the perspective of Chinese and US payers, applying discount rates of 3% and 5% to costs and utilities, respectively” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“For US payers, we set the willing to pay (WTP) threshold to $150,000/QALY.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“For US payers, the placebo plus chemotherapy group had a total cost of $56,157.05 and a utility of 1.10 QALYs, while the durvalumab plus chemotherapy group had a total cost of $217,069.25, a utility of 1.52 QALYs, resulting in an ICER of $381,864.39/QALY.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“From the perspective of the Chinese payers, compared to the chemotherapy group, the durvalumab plus chemotherapy group incurred an additional cost of $154,904.98, resulting in an ICER of 367,608.51 /QALY” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“For US and Chinese payers, under the respective willing to pay thresholds, the likelihood of the durvalumab plus chemotherapy arm being cost-effective was 0%.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Pembrolizumab plus chemotherapy versus placebo plus chemotherapy in first-line advanced biliary tract cancer, United States and China: Jiang et al. (2025)

Relevance: Evaluates pembrolizumab plus chemotherapy against placebo plus chemotherapy in first-line advanced biliary tract cancer from United States and Chinese payer perspectives, the first-line setting in which section 2 lists the KEYNOTE-966 regimen.

“This study aimed to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy compared with placebo plus chemotherapy from the perspective of US and Chinese payers.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The models included three health states: PFS, progressive disease (PD) and death” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Each treatment cycle was set at 3 weeks, and a 10-year time horizon with half-cycle correction was applied based on the previous data about BTC.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Costs and QALYs were discounted at an annual rate of 3%. The willingness-to-pay (WTP) threshold was set at three times the gross domestic product per capita, resulting in US$210,746/QALY for the USA and $37,669/QALY for China.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The treatment increased costs by US$97 222.13 in the US and $43 312.02 in China, resulting in ICERs of US$810 184.42 and $360 933.50 per QALY, respectively.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Further analyses suggested that the optimal price of pembrolizumab in the USA would be nearly US$10.33 /mg, while a price reduction of over 90% would be required for the combined therapy to be cost-effective for patients in China.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Pembrolizumab plus chemotherapy versus chemotherapy alone in first-line advanced biliary tract cancer, United States and China: Zhang et al. (2026)

Relevance: Evaluates pembrolizumab with chemotherapy against chemotherapy alone in advanced biliary tract cancer from United States and Chinese perspectives, the first-line KEYNOTE-966 regimen listed in section 2.

“We constructed a partitioned survival model form the perspectives of US and Chinese payers. KEYNOTE-966 was used to obtain the baseline characteristics of the patients as well as their clinical data.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“There were deaths in more than 98% of patients in both treatment arms with a 10-year time horizon, which means we considered it a lifetime study” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In China, costs (converted to US dollars) and utilities were discounted at 5%, whereas in the United States, both costs and utilities were discounted at 3%” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Based on comparison of the ICER between pembrolizumab plus chemotherapy and chemotherapy alone, the ICER for pembrolizumab plus chemotherapy was $466,340 per QALY (> WTP of $84,866) and $976,925/QALY (> WTP of $150,000) for the China and the US, respectively.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In addition, we performed an alternative analysis focusing only on PFS. In China and the US, the ICER for pembrolizumab plus chemotherapy compared with that of chemotherapy alone was $535,405/QALY and $1,118,607/QALY.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Moreover, for pembrolizumab plus chemotherapy, the INHB was −0.616 QALYs and the INMB was -$52,237 when the WTP threshold for China was $84,866 per QALY, and for US, the INHB was −0.796 QALYs and the INMB was -$119,400.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Pembrolizumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin in first-line advanced cholangiocarcinoma, United States: Wang et al. (2025)

Relevance: Evaluates pembrolizumab added to gemcitabine and cisplatin as first-line treatment of advanced cholangiocarcinoma from a United States health care payer perspective, the first-line regimen listed in section 2 that precedes the previously treated setting.

Pembrolizumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin in first-line advanced biliary tract cancer, China, Japan, United States, and Switzerland: Xie et al. (2025)

Relevance: Evaluates first-line pembrolizumab with chemotherapy against chemotherapy alone in advanced biliary tract cancer in the United States, China, Japan, and Switzerland.

“This study employs a partitioned survival analysis model (PartSA) to conduct a cross-country cost-effectiveness evaluation, incorporating treatment cost and utility data from China, Japan, the United States, and Switzerland.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The model employed a 21-day cycle and a time horizon of 10 years, by which point nearly all patients in both groups had transitioned to the death state.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Discount rates for costs and utilities were established at 5% for China ( 17 ), 3% for Japan ( 18 ), 3% for the United States ( 19 ), and 3% for Switzerland” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Compared to chemotherapy alone, the additional costs for combination therapy in China, Japan, the United States, and Switzerland were $74,621.78, $44,014.83, $160,169.86, and $163,631.09, respectively; the QALY gains were 0.14, 0.14, 0.14, and 0.15, respectively. The cost per additional QALY gained was $542,441.16, $314,213.67, $1,104,628.40, and $1,069,496.82, respectively.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“When comparing the ICER values of the four countries with their respective WTP thresholds, the results indicated that the ICER values for combination therapy were significantly higher than the WTP thresholds in all four countries” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In the United States, Japan, and Switzerland, an 80–95% reduction in pembrolizumab’s price was necessary for cost-effectiveness, while in China, a reduction greater than 95% was required.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Gemcitabine plus cisplatin versus gemcitabine monotherapy in advanced biliary tract cancer, United States: Roth and Carlson (2012)

Relevance: Evaluates gemcitabine with cisplatin against gemcitabine monotherapy in advanced biliary tract cancer in the United States, the chemotherapy backbone of the first-line regimens listed in section 2.

“Based on the ABC-02 findings, this analysis seeks to evaluate the cost-utility of adding cisplatin to standard gemcitabine therapy from a U.S. societal perspective.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“A decision-analytic model was developed to estimate direct medical costs, patient time costs, and quality-adjusted life-years (QALYs) for two treatment strategies: (1) gemcitabine + cisplatin, (2) gemcitabine monotherapy.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Total QALYs for the gemcitabine + cisplatin and gemcitabine monotherapy strategies were 0.751 and 0.561, respectively. Total costs were $44,885 and $33,653 respectively.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Relative to gemcitabine monotherapy, gemcitabine + cisplatin had an incremental cost-effectiveness ratio (ICER) of $59,480 per QALY gained.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“In the PSA, gemcitabine monotherapy had the highest probability of being cost-effective until a willingness-to-pay of $60,000, after which the gemcitabine + cisplatin strategy had the highest probability.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Related diseases and analogous treatments

No evidence found.

Utility weights

Utility weights from analyses of Lirafugratinib (Lyrfigtu and RLY-4008)

No evidence found.

Utility weights for the same indication

Utility weights for progression-free and progressed states, intravenous therapy, and grade 3 or higher adverse events, advanced intrahepatic cholangiocarcinoma: Chueh et al. (2023)

Relevance: Utilities for the progression-free and disease-progressed states of advanced intrahepatic cholangiocarcinoma in a model of second-line pemigatinib, with disutilities for intravenous therapy and for severe adverse events.

Access: Not open access

Not quoted: The utility weights are reported in the full text, which is closed access.

Utility weights for the same disease in other populations or settings

Utility weights for progression-free and progressed states, advanced biliary tract cancer, United States and China: Jiang et al. (2025)

Relevance: Utilities for the progression-free and progressive disease states of advanced biliary tract cancer applied to the United States and China.

Utility weights for treatment without adverse events, progression, and individual adverse events, advanced cholangiocarcinoma: Wang et al. (2025)

Relevance: Utilities for treatment and progression states of advanced cholangiocarcinoma with disutilities for individual adverse events, from a United States model of first-line pembrolizumab with gemcitabine and cisplatin.

Utility weights for progression-free and progressed cholangiocarcinoma: Chen et al. (2024b)

Relevance: Utilities for the progression-free and progressed states of cholangiocarcinoma, applied as tumor-specific health-state utility values.

Access: Free full text

Utility weights before and after progression and with an adverse event, advanced biliary tract cancer: Roth and Carlson (2012)

Relevance: Utilities for advanced biliary tract cancer before and after progression and with an adverse event, from a United States model of gemcitabine-based chemotherapy.

Access: Not open access

Not quoted: The utility weights are reported in the full text, which is closed access.

Utility weights for related diseases and analogous treatments

No evidence found.

Search strategy

DatasetQueryResults
Methodslirafugratinib OR "RLY-4008" OR Lyrfigtu0
Ratioscholangiocarcinoma OR "biliary tract" OR "bile duct" OR "gallbladder"119
Ratiosfutibatinib OR pemigatinib OR infigratinib OR erdafitinib5
Ratiosivosidenib OR zanidatamab OR "liposomal irinotecan"4
Methodscholangiocarcinoma OR "biliary tract cancer" OR "biliary cancer" OR "gallbladder cancer"30
Methods"fibroblast growth factor receptor" OR FGFR2
MethodsFOLFOX AND (cholangiocarcinoma OR biliary)2
Methods"active symptom control" OR "best supportive care" AND biliary1
Weightscholangiocarcinoma OR "biliary tract" OR "biliary cancer" OR "gallbladder cancer"123
Weightshyperphosphatemia OR stomatitis OR "palmar-plantar" OR "hand-foot"124
Methodsfutibatinib OR Lytgobi OR erdafitinib1