title: Cost-effectiveness analysis of adjuvant chemotherapies in patients presenting with gastric cancer after D2 gastrectomy.
abstract: BACKGROUND
  To analyze and compare the economic outcomes of adjuvant chemotherapy with capecitabine plus oxaliplatin (referred to as the XELOX strategy) and of S-1 (the S-1 strategy) for gastric cancer patients after D2 gastrectomy.
  
  
  METHODS
  A Markov model was developed to simulate the lifetime disease course associated with stage II or III gastric cancer after D2 gastrectomy. The lifetime quality-adjusted life years (QALYs), associated costs, and incremental cost-effectiveness ratios (ICERs) were estimated. The clinical data were derived from the results of pilot studies. Direct costs were estimated from the perspective of the Chinese healthcare system, and the utility data were measured from end-point observations of Chinese patients. Sensitivity analyses were used to explore the impact of uncertainty on the model's outcomes.
  
  
  RESULTS
  The combined adjuvant chemotherapy strategy with XELOX yielded the greatest increase in QALYs over the course of the disease (8.1 QALYs compared with 7.8 QALYs for the S-1 strategy and 6.2 for surgery alone). The incremental cost per QALY gained using the XELOX strategy was significantly lower than that for the S-1 strategy ($3,502 vs. $6,837, respectively). The results were sensitive to the costs of oxaliplatin and the hazard ratio of relapse-free survival.
  
  
  CONCLUSIONS
  The observations reported herein suggest that adjuvant therapy with capecitabine plus oxaliplatin is a highly cost-effective strategy and more favorable treatment option than the S-1 strategy in patients with stage II or III gastric cancer who have undergone D2 gastrectomy.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: Te
authors.initials: T
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Cai
authors.forename: Yuejuan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. zhaogangrjgs@126.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant / Q000191:economics; D002681:China; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D018572:Disease-Free Survival; D004338:Drug Combinations; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D005743:Gastrectomy; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D010071:Oxaloacetates; D010094:Oxonic Acid / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery; D015996:Survival Rate; D005641:Tegafur / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; D010071:Oxaloacetates; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000069287:Capecitabine; D005472:Fluorouracil