title: Economic evaluation of first-line adjuvant chemotherapies for resectable gastric cancer patients in China.
abstract: BACKGROUND
  First-line postoperative adjuvant chemotherapies with S-1 and capecitabine and oxaliplatin (XELOX) were first recommended for resectable gastric cancer patients in the 2010 and 2011 Chinese NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer; however, their economic impact in China is unknown.
  
  
  OBJECTIVE
  The aim of this study was to compare the cost-effectiveness of adjuvant chemotherapy with XELOX, with S-1 and no treatment after a gastrectomy with extended (D2) lymph-node dissection among patients with stage II-IIIB gastric cancer.
  
  
  METHODS
  A Markov model, based on data from two clinical phase III trials, was developed to analyse the cost-effectiveness of patients in the XELOX group, S-1 group and surgery only (SO) group. The costs were estimated from the perspective of Chinese healthcare system. The utilities were assumed on the basis of previously published reports. Costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were calculated with a lifetime horizon. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  For the base case, XELOX had the lowest total cost ($44,568) and cost-effectiveness ratio ($7,360/QALY). The relative scenario analyses showed that SO was dominated by XELOX and the ICERs of S-1 was $58,843/QALY compared with XELOX. The one-way sensitivity analysis showed that the most influential parameter was the utility of disease-free survival. The probabilistic sensitivity analysis predicted a 75.8% likelihood that the ICER for XELOX would be less than $13,527 compared with S-1. When ICER was more than $38,000, the likelihood of cost-effectiveness achieved by S-1 group was greater than 50%.
  
  
  CONCLUSIONS
  Our results suggest that for patients in China with resectable disease, first-line adjuvant chemotherapy with XELOX after a D2 gastrectomy is a best option comparing with S-1 and SO in view of our current study. In addition, S-1 might be a better choice, especially with a higher value of willingness-to-pay threshold.
authors: Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China ; School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, People's Republic of China.
authors: Chongqing
authors: C
authors: Tan
authors: Liubao
authors: L
authors: Peng
authors: Xiaohui
authors: X
authors: Zeng
authors: Jianhe
authors: J
authors: Li
authors: Xiaomin
authors: X
authors: Wan
authors: Gannong
authors: G
authors: Chen
authors: Lidan
authors: L
authors: Yi
authors: Xia
authors: X
authors: Luo
authors: Ziying
authors: Z
authors: Zhao
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics; D001499:Bayes Theorem; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant / Q000191:economics*; D002681:China; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000191:economics; D018450:Disease Progression; D018572:Disease-Free Survival; D004338:Drug Combinations; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000191:economics; D005743:Gastrectomy; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D010071:Oxaloacetates; D010094:Oxonic Acid / Q000191:economics; D011336:Probability; D019057:Quality-Adjusted Life Years; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000601:surgery*; D005641:Tegafur / Q000191:economics
chemical_list: D004338:Drug Combinations; D010071:Oxaloacetates; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000069287:Capecitabine; D005472:Fluorouracil