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. 2021 Nov 9;5(6):zrab129.
doi: 10.1093/bjsopen/zrab129.

Economic cost-utility analysis of stage-directed gastric cancer treatment

Arfon G Powell  1 , Jennifer R Wheat  2 , Catherine Eley  2 , David Robinson  2 , Stuart A Roberts  3 , Wyn Lewis  2
Affiliations

Economic cost-utility analysis of stage-directed gastric cancer treatment

Arfon G Powell et al. BJS Open. .

Abstract

Background: Gastric cancer (GC) treatment levies substantial financial burden on health services. Potentially curative surgery with or without chemotherapy is offered to patients with locoregional disease. This study aimed to examine treatment costs related to life-years gained in patients having potentially curative treatment (gastrectomy) and those receiving best supportive care (BSC).

Methods: Some 398 consecutive patients with GC were classified according to treatment modality (116 BSC, 282 gastrectomy). Cost calculations for 1 year's treatment from referral were made according to network diagnostic, staging and treatment algorithms. Primary outcome was overall survival (OS).

Results: GC median survival after BSC was 8 months, costing €5413, compared with gastrectomy median survival of 34 months, costing €22 753 for 1 year's treatment: cost per life-year gained €9319. Cost incurred for stage I GC was €22 434, stage II €23 498, stage III €22 445, and stage IV €22 032. Based on these values, the cost per quality adjusted life-year (QALY) for BSC for stage I GC was -€8335 stage II -€8952, stage III -€11 317, and stage IV -€25 669.

Conclusion: Potentially curative treatment that included gastrectomy improved OS four-fold compared with BSC and was cost-effective at national thresholds of readiness to pay per QALY.

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Figures

Fig. 1
Fig. 1
Gastric cancer treatment Treatment stratified by stage and modality: quality adjusted life-year (QALY)-adjusted median survival and cost per QALY
Fig. 2
Fig. 2
Cost-effectiveness of gastric cancer treatment stratified by stage and treatment modality BSC, best supportive care; S, surgery; CS, perioperative chemotherapy; CS1 and S1, pTNM stage I gastric cancer (GC) treated with perioperative chemotherapy and surgery respectively; CS2 and S2, pTNM stage II GC treated with perioperative chemotherapy and surgery respectively; CS3 and S3, pTNM stage III GC treated with perioperative chemotherapy and surgery respectively; CS4 and S4, pTNM stage IV GC treated with perioperative chemotherapy and surgery respectively (intention to treat).
See this image and copyright information in PMC

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