Locally Advanced Gastric Cancer Management: A Cost-Effectiveness Analysis

Area of Science:

• Oncology
• Health Economics
• Decision Analysis

Background:

• Locally advanced gastric cancer (LAGC) is managed via upfront surgery (US) or perioperative chemotherapy (PCT).
• Preoperative therapies like PCT show survival benefits over US, suggesting outcome variations.
• Understanding cost-effectiveness is crucial for optimal LAGC treatment selection.

Purpose of the Study:

• To compare the costs and quality-of-life (QALYs) of US versus PCT for LAGC.
• To identify the most cost-effective treatment strategy for LAGC patients in the US.

Main Methods:

• A decision tree model was developed to analyze survival and costs over a 6-month horizon.
• Costs were based on 2022 Medicare reimbursement rates from a third-party payer perspective.
• Effectiveness was measured in QALYs; sensitivity analyses (one-way, two-way, probabilistic) tested model robustness.

Main Results:

• PCT yielded 3.11 QALYs at a cost of $40,792.16, making it the most cost-effective option.
• US cost $55,575.57 for 3.15 QALYs, with an incremental cost-effectiveness ratio (ICER) of $369,585.25.
• Sensitivity analyses and 100,000 Monte Carlo simulations consistently favored PCT.

Conclusions:

• Perioperative chemotherapy (PCT) is the most cost-effective strategy for managing LAGC.
• Despite slightly lower QALYs, PCT's significantly lower cost justifies its use over upfront surgery (US).
• This analysis provides valuable economic data for clinical decision-making in LAGC treatment.