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. 2025 Jul 21:13:1644176.
doi: 10.3389/fpubh.2025.1644176. eCollection 2025.

Cost-effectiveness analysis of cadonilimab plus chemotherapy as a first-line treatment option in HER-2-negative advanced gastric cancer

Longfeng Zhang #  1 , Qingsheng Yang #  2 , Zhiwei Zheng  3
Affiliations

Cost-effectiveness analysis of cadonilimab plus chemotherapy as a first-line treatment option in HER-2-negative advanced gastric cancer

Longfeng Zhang et al. Front Public Health. .

Abstract

Objective: This study aims to evaluate the cost-effectiveness of using cadonilimab plus chemotherapy compared to chemotherapy in HER-2-negative advanced gastric cancer from the perspective of the Chinese healthcare system.

Methods: A cost-effectiveness analysis was conducted utilizing a partitioned survival model to simulate the expected costs and outcomes associated with the treatment of patients with cadonilimab in combination with chemotherapy versus chemotherapy over a 10 years lifetime horizon. Cost data were sourced from published literature and national databases. Data on treatment efficacy, adverse events, and transition probabilities were derived from the phase 3 COMPASSION-15 trial. The WTP threshold in this study was established at 40,343.68 USD per QALY. Sensitivity analyses were performed to evaluate the robustness of the results and assess the impact of variations in key parameters on the cost-effectiveness outcomes.

Results: The base case analysis revealed that in all population of randomized patients, treatment with cadonilimab resulted in an incremental gain of 1.08 QALYs compared to chemotherapy, at an incremental cost of 58,862.61 USD. The ICER for this cohort was calculated to be 54,502.42 USD per QALY. In the subgroup of patients with a PD-L1 CPS ≥ 5, patients treated with cadonilimab experienced a greater increase in 1.33 QALYs compared to chemotherapy, at an incremental cost of 35,661.87 USD. The ICER for this subgroup was 26,813.44 USD per QALY. Sensitivity analyses conducted demonstrated the robustness of the results to variations in model inputs and assumptions. Moreover, the probabilistic sensitivity analysis indicated that cadonilimab in combination with chemotherapy had a 4.70 and 93.90% probabilities of being considered cost-effective at a WTP threshold of 40,343.68 USD per QALY for the all randomized patient group and the subgroup of patients with a PD-L1 CPS ≥ 5, respectively.

Conclusion: The addition of cadonilimab to standard chemotherapy for first line treatment of HER-2-negative advanced gastric cancer may not be considered a cost-effective option compared to chemotherapy alone. However, for the subgroup of patients with PD-L1CPS ≥ 5, the ICER was 26,813.44 USD per QALY, indicating that this treatment approach could potentially be deemed cost-effective in China.

Keywords: HER-2-negative; advanced gastric cancer; cadonilimab; chemotherapy; cost-effectiveness analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The structure of the model.
Figure 2
Figure 2
The results of the one-way sensitivity analysis for all randomized populations (The red bars indicate the impact of the parameter on the outcome following an increase in the base value, while the blue bars represent the impact of the parameter on the outcome following a decrease in the base value).
Figure 3
Figure 3
The results of the PSA for all randomized populations.
Figure 4
Figure 4
The results of the one-way sensitivity analysis for the PD-L1 CPS ≥ 5 subgroup populations (The red bars indicate the impact of the parameter on the outcome following an increase in the base value, while the blue bars represent the impact of the parameter on the outcome following a decrease in the base value).
Figure 5
Figure 5
The cost-effectiveness acceptability curve of the PSA for the PD-L1 CPS ≥ 5 subgroup populations.
Figure 6
Figure 6
The scatter plot of the PSA for the PD-L1 CPS ≥ 5 subgroup populations.
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