Camrelizumab plus CAPOX versus CAPOX for HER2-negative gastric or gastro-oesophageal junction adenocarcinoma: a
Ling Fang1, Longfeng Zhang2, Lisheng Huang3
1Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Objective:
This study was to assess the cost-effectiveness of camrelizumab in combination with capecitabine plus oxaliplatin (CAPOX) compared to CAPOX for human epidermal growth factor receptor 2 (HER2)-negative advanced gastric or gastro-oesophageal junction adenocarcinoma (GC/GEJC) in China.
Methods:
A partitioned survival model was constructed to simulate the 10-year disease progression with HER2-negative advanced GC/GEJC treatment scenarios. Survival data for the model were sourced from NCT03813784 clinical trial. The costs considered in the model included drug costs, management costs for severe adverse events, subsequent treatment costs, and best supportive care costs. Health outcomes were measured in quality-adjusted life year (QALY). The willingness-to-pay (WTP) threshold was defined as 41,876.05 USD per QALY. Sensitivity analyses were conducted to assess the robustness of the model results.
Results:
In the overall study population, the camrelizumab plus CAPOX had an incremental cost of 10,688.44 USD and an additional 1.13 QALYs compared to the CAPOX group. This resulted in an incremental cost-effectiveness ratio (ICER) of 9,458.80 USD per QALY. In the PD-L1 positive subgroup, the addition of camrelizumab to CAPOX in this subgroup led to an incremental QALY gain of 1.17, resulting in an ICER of 9,183.07 USD per QALY. The ICER values observed in both groups were found to be below the WTP thresholds. The results of the one-way sensitivity analysis showed that changes in the input parameters did not substantially alter the conclusion. The probabilistic sensitivity analysis indicated that the probability of camrelizumab plus CAPOX being cost-effective was 100% at the WTP threshold of 41,876.05 USD per QALY.
Conclusion:
Camrelizumab with CAPOX demonstrates cost-effectiveness as a first-line treatment option for patients with advanced HER2-negative GC/GEJC. This regimen offers promising clinical outcomes while also being economically feasible within the context of China's healthcare system.
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