Cost-effectiveness analysis of chemotherapy for advanced gastric cancer in China

Abstract

Aim: To assess the economics of various chemotherapeutic regimens for advanced gastric cancer (AGC), and to select the best cost-effective regimen for the common Chinese patients.

Methods: Data source used in this study was the Chinese Biomedical Disk Database. Patients were diagnosed as AGC and any regimen was eligible. Outcome measures included median survival time (MST) and percentage of complete and partial response (CR+PR). Economic statistics was per capita direct medical cost (DMC) of a single cycle. TreeAge Pro Healthcare 2007 software was used to carry out cost-effectiveness and incremental cost-effectiveness analysis. Sensitivity analyses were applied by altering willingness-to-pay and annual discount rate, and also re-analyzed by excluding the studies with apparent heterogeneity.

Results: Seven retrospective economics studies on 760 patients were included. 5-fluorouracil-based regimens were universal, and also some new agents were involved, such as docetaxel, paclitaxel, and oxaliplatin. By processing analysis, we could recommend etoposide, leucovorin and 5-fluorouracil (ELF) regimen as preference, with a DMC/MST ratio of 2543 RBM/11.7 mo and a DMC/CR+PR ratio of 2543 RMB/53.3%. Uracil-tegafur, etoposide and cisplatin (FEP) or 5-fluorouracil, adrimycin/epirubin and mitomycin (FAM) regimens could be regarded as optional first-line chemotherapy for AGC in common Chinese patients. With no regard for willingness-to-pay, the docetaxel, cisplatin and 5-fluorouracil (DCF) regimen could be chosen as either a first- or a second-line chemotherapy, with a DMC/CR+PR ratio of 9979 RMB/56.3%.

Conclusion: 5-fluorouracial regimens are still considered the mainstream for AGC, while new agents such as taxanes are optional. More randomized clinical trials are required before any mandatory recommendation of certain regimens for patients with AGC in China is made.

Figure 1

Plots of cost-effectiveness analyses for DMC/MST data (the MST data of TCF, DCF and FOLFOX regimens were not reported) (A), and DMC/CR+PR (B). The regimens under the line are dominated in incremental cost-effectiveness analyses.

Figure 2

Sensitivity analyses by altering the willingness-to-pay from 1000 RMB to 10 000 RMB for DMC, DMC/MST data (the MST data of TCF, DCF and FOLFOX regimens were not reported) (A), and DMC/CR+PR (the curves for FAM, UFTM, LFP/M, FAMTX and ECF regimens are below the bottom of the chart) (B).

Figure 3

Sensitivity analysis by altering the annual discount rate from 1% to 10% for DMC, DMC/MST data (the MST data of TCF, DCF and FOLFOX regimens were not reported) (A), and DMC/CR+PR (the curve for DCF regimen is beyond the top of the chart) (B).