ORIGINAL RESEARCH Real-World Analysis of Treatment Patterns, Healthcare Utilization, Costs, and Mortality Among People with Biliary Tract Cancers in the USA Marcus J. Healey . Brian Seal . Nicole Princic . Danae Black . Elisabetta Malangone-Monaco . Nilofer S. Azad . Rory L. Smoot Received: August 5, 2022 / Accepted: September 28, 2022 Ó The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature 2022 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 fol- lowing surgery. This study adds to current lit- erature 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 adminis- trative 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 dura- tion 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, respec- tively) 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 dura- tion, 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 M. J. Healey Á B. Seal AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA N. Princic (&) Á D. Black Á E. Malangone-Monaco Real World Data Research & Analytics, Merative, Previously IBM Watson Health, 75 Binney St, Cambridge, MA 02142, USA e-mail: nprincic@merative.com N. S. Azad John Hopkins School of Medicine, Baltimore, MD, USA R. L. Smoot Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, NY, USA Adv Ther https://doi.org/10.1007/s12325-022-02342-8