A cost-effectiveness analysis of adjuvant chemoradiotherapy for resected gastric cancer.
BACKGROUND
The Intergroup 0116 trial demonstrated that adding postoperative chemoradiotherapy for gastric cancer resulted in a significant overall survival improvement of 9 months. The purpose of this study was to perform a cost-effectiveness analysis of adjuvant chemoradiotherapy for resected gastric cancer.


METHODS
An economic model was constructed to examine the costs and quality-adjusted survival benefit of adjuvant chemoradiotherapy for gastric cancer. Medicare reimbursement rates were used for chemotherapy and radiotherapy costs. Costs of managing toxicities were also included. Patient utilities were derived from published literature. The analysis was performed from the third-party payer perspective, with results reported in 2007 US dollars. A lifetime time horizon and 3% discount rate were used. One-way and Monte Carlo probabilistic sensitivity analyses were performed.


RESULTS
For the base case, the incremental cost of adding adjuvant chemoradiotherapy was $20,100. The net gain in quality-adjusted life years (QALYs) was 0.53. The incremental cost-effectiveness ratio (ICER) was $38,400/QALY. The probabilistic sensitivity analysis predicted a 67% likelihood that the ICER would be less than $50,000/QALY.


CONCLUSIONS
Our model suggests that the ICER of adjuvant chemoradiotherapy for resected gastric cancer compares favorably to other widely used cancer treatments.
Wang
Samuel J
SJ
Fuller
Clifton D
CD
Choi
Mehee
M
Thomas
Charles R
CR