Comparative Cost-Effectiveness Analysis of Multiple First-Line Treatments for HER2-Negative Unresectable Advanced or...

Area of Science:

• Oncology
• Health Economics
• Pharmacoeconomics

Background:

• HER2-negative unresectable advanced or recurrent gastric cancer (GC) presents a significant therapeutic challenge with a poor prognosis.
• Evaluating cost-effectiveness is crucial for optimizing healthcare resource allocation in GC treatment.

Purpose of the Study:

• To compare the cost-effectiveness of various first-line treatment options for HER2-negative unresectable advanced or recurrent GC.
• To identify the most cost-effective strategy from the perspective of a Japanese healthcare payer.

Main Methods:

• A partitioned survival model was utilized to estimate long-term costs and quality-adjusted life years (QALYs).
• Network meta-analysis provided hazard ratios for regimen comparisons.
• Cost data were sourced from a Japanese medical claims database, and incremental cost-effectiveness ratios (ICERs) were calculated.

Main Results:

• S-1 and oxaliplatin (SOX), capecitabine and oxaliplatin (CapeOx), and pembrolizumab plus chemotherapy were on the efficiency frontier.
• SOX demonstrated the highest probability (40.33%) of being the most cost-effective treatment in probabilistic sensitivity analysis.
• The ICER for SOX versus CapeOx was USD 85,649/QALY.

Conclusions:

• SOX emerged as the most cost-effective first-line treatment for HER2-negative unresectable advanced or recurrent GC in Japan.
• This conclusion holds at a willingness-to-pay threshold of USD 100,000/QALY, aligning with Japan's health technology assessment standards.