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Economic Evaluation of First-Line Adjuvant Chemotherapies for Resectable Gastric Cancer Patients in China

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  • Chongqing Tan
  • Liubao Peng
  • Xiaohui Zeng
  • Jianhe Li
  • Xiaomin Wan
  • Gannong Chen
  • Lidan Yi
  • Xia Luo
  • Ziying Zhao

Abstract

Background: First-line postoperative adjuvant chemotherapies with S-1 and capecitabine and oxaliplatin (XELOX) were first recommended for resectable gastric cancer patients in the 2010 and 2011 Chinese NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer; however, their economic impact in China is unknown. Objective: The aim of this study was to compare the cost-effectiveness of adjuvant chemotherapy with XELOX, with S-1 and no treatment after a gastrectomy with extended (D2) lymph-node dissection among patients with stage II-IIIB gastric cancer. Methods: A Markov model, based on data from two clinical phase III trials, was developed to analyse the cost-effectiveness of patients in the XELOX group, S-1 group and surgery only (SO) group. The costs were estimated from the perspective of Chinese healthcare system. The utilities were assumed on the basis of previously published reports. Costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were calculated with a lifetime horizon. One-way and probabilistic sensitivity analyses were performed. Results: For the base case, XELOX had the lowest total cost ($44,568) and cost-effectiveness ratio ($7,360/QALY). The relative scenario analyses showed that SO was dominated by XELOX and the ICERs of S-1 was $58,843/QALY compared with XELOX. The one-way sensitivity analysis showed that the most influential parameter was the utility of disease-free survival. The probabilistic sensitivity analysis predicted a 75.8% likelihood that the ICER for XELOX would be less than $13,527 compared with S-1. When ICER was more than $38,000, the likelihood of cost-effectiveness achieved by S-1 group was greater than 50%. Conclusions: Our results suggest that for patients in China with resectable disease, first-line adjuvant chemotherapy with XELOX after a D2 gastrectomy is a best option comparing with S-1 and SO in view of our current study. In addition, S-1 might be a better choice, especially with a higher value of willingness-to-pay threshold.

Suggested Citation

  • Chongqing Tan & Liubao Peng & Xiaohui Zeng & Jianhe Li & Xiaomin Wan & Gannong Chen & Lidan Yi & Xia Luo & Ziying Zhao, 2013. "Economic Evaluation of First-Line Adjuvant Chemotherapies for Resectable Gastric Cancer Patients in China," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.
    • Handle: RePEc:plo:pone00:0083396
    DOI: 10.1371/journal.pone.0083396
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    References listed on IDEAS

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    1. Bin Wu & Baijun Dong & Yuejuan Xu & Qiang Zhang & Jinfang Shen & Huafeng Chen & Wei Xue, 2012. "Economic Evaluation of First-Line Treatments for Metastatic Renal Cell Carcinoma: A Cost-Effectiveness Analysis in A Health Resource–Limited Setting," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-13, March.
    2. Peng Liubao & Wan Xiaomin & Tan Chongqing & Jon Karnon & Chen Gannong & Li Jianhe & Cui Wei & Luo Xia & Cao Junhua, 2009. "Cost-Effectiveness Analysis of Adjuvant Therapy for Operable Breast Cancer from a Chinese Perspective," PharmacoEconomics, Springer, vol. 27(10), pages 873-886, October.
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    1. Jingyuan Peng & Chongqing Tan & Xiaohui Zeng & Shikun Liu, 2018. "Cost-effectiveness analysis of capecitabine monotherapy versus capecitabine plus oxaliplatin in elderly patients with advanced gastric cancer," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-12, June.

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