Cost-effectiveness of targeted therapy versus chemotherapy for patients with advanced or metastatic gastric cancer in China.

BACKGROUND

Multi-biomarker testing increasingly guides first-line therapy for advanced or metastatic gastric cancer in China, but its economic value is uncertain.

METHODS

We conducted a Chinese healthcare payer-perspective cost-effectiveness analysis comparing a testing-guided pathway with No-testing, using a hybrid decision tree plus three-state Markov model for a 1,000-patient cohort over 10 years.

RESULTS

Testing-guided care increased costs by $64,242.13 and quality-adjusted life years (QALYs) by 0.63, yielding an incremental cost-effectiveness ratio (ICER) of $101,278.5/QALY and failing to meet the willingness to pay (WTP) threshold. Probabilistic sensitivity analysis (PSA) showed 0% probability of cost-effectiveness at $40,629/QALY; key one-way drivers included progression-free (PF) utility and zolbetuximab cost.

CONCLUSIONS

Biomarker-guided treatment improved outcomes but was not cost-effective in China at current prices, mainly due to high drug costs in large biomarker-defined groups. Value-based pricing may improve affordability and cost-effectiveness.