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ABSTRACT
Background
This study compares first-line pembrolizumab plus chemotherapy with chemotherapy alone for patients with HER2-negative advanced gastric cancer (GC) and gastroesophageal junction cancer (GEJC) in China.
Methods
A Markov state-transition model was developed based on the phase 3 randomized KEYNOTE-859 clinical trial data. The health state utility values and direct medical costs were derived from the KEYNOTE-859 clinical trial, the relevant literature, and local charges. The measured outcomes included quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER). Probabilistic and one-way sensitivity analyses (OWSA) were performed to assess the uncertainty of the model.
Results
In the base analysis, the incremental effectiveness and cost of pembrolizumab plus chemotherapy versus chemotherapy alone were 0.22 QALYs and $16,627.31, respectively, resulting in an ICER of $76,936.60/QALY, which is higher than the willingness-to-pay threshold in China ($35,864.61/QALY). Subgroup analyses revealed that the ICERs of pembrolizumab plus chemotherapy versus chemotherapy alone were $72,762.68 and $34,813.70 in the populations with PD-L1 CPS of 1 or higher (CPS ≥ 1) and PD-L1 CPS ≥ 10 (CPS ≥ 10), respectively.
Conclusions
As first-line therapy for patients with locally advanced or metastatic HER2-negative GC/GEJC in China, pembrolizumab plus chemotherapy is less cost-effective than chemotherapy alone, however, in the CPS ≥ 10 subgroup is more.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Acknowledgment
We thank Bei Huang, Gaofeng Zhang and Dongmei Zhong for their help with acquisition, analysis and interpretation of the study data
Reviewer disclosures
The peer reviewers on this manuscript do not have relevant financial or other relationships to disclose.
Author contributions
Concept and design: W Lang, L Deng. Acquisition of data: W Lang, L Deng. Analysis and interpretation of data: W Lang. Drafting of the manuscript: W Lang, M Lu, M Ouyang. Critical revision of the paper for important intellectual content: W Lang, L Deng, M Ouyang. Statistical analysis: W Lang. Supervision: W Lang, M Lu, M Ouyang.
Data availability statement
The study includes original contributions, which can be found in the article/online supplementary material. For further inquiries, please contact the corresponding author.