Cost-effectiveness of adjuvant chemotherapy for curatively resected gastric cancer with S-1

BMC Cancer

Akinori Hisashige¹  Mitsuru Sasako²  Toshifusa Nakajima³ 

[1] The Institute of Healthcare Technology Assessment, 2-24-10, Shomachi, 770-0044, Tokushima, Japan

[2] Department of Upper Gastrointestinal Surgery, Hyogo College of Medicine, 663-8501, Hyogo, Japan

[3] Division of Surgery, The Cancer Institute Hospital, 135-8550, Tokyo, Japan

关键词: Quality-adjusted life-year;    Cost-effectiveness;    Gastric cancer;    Adjuvant therapy;    S-1;    Chemotherapy;   

Others  :  1079548
DOI  :  10.1186/1471-2407-13-443

 received in 2013-02-28, accepted in 2013-09-26,  发布年份 2013

【 摘 要 】

Background

The effectiveness of specific regimens of adjuvant therapy for gastric cancer has not been verified by large clinical trials. Recently, several large trials attempted to verify the effectiveness of adjuvant therapy. The Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer in Japan, a randomized controlled trial of adjuvant S-1 therapy for resected gastric cancer, demonstrated significant improvement in overall and relapse-free survival, compared to surgery alone. To evaluate value for money of S-1 therapy, cost-effective analysis was carried out.

Methods

The analysis was carried out from a payer’s perspective. As an economic measure, cost per quality-adjusted life-year (QALY) gained was estimated. Overall survival was estimated by the Kaplan-Meier method, up to 5-year observation. Beyond this period, it was simulated by the modified Boag model. Utility score is derived from interviews with sampled patients using a time trade-off method. Costs were estimated from trial data during observation, while in the period beyond observation they were estimated using simulation results. To explore uncertainty of the results, qualitative and stochastic sensitivity analyses were done.

Results

Adjuvant S-1 therapy gained 1.24 QALYs per patient and increased costs by $3,722 per patient for over lifetime (3% discount rate for both effect and costs). The incremental cost-effectiveness ratio (95% confidence intervals) for over lifetime was estimated to be $3,016 ($1,441, $8,840) per QALY. The sensitivity analyses showed the robustness of these results.

Conclusion

Adjuvant S-1 therapy for curatively resected gastric cancer is likely cost-effective. This therapy can be accepted for wide use in Japan.

【 授权许可】

   
2013 Hisashige et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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