title: Cost-effectiveness analysis of apatinib treatment for chemotherapy-refractory advanced gastric cancer.
abstract: BACKGROUND
  Apatinib, a third-line or later treatment for advanced gastric cancer (aGC), was shown to improve overall survival and progression-free survival (PFS) compared with placebo in the phase III trial. Given the modest benefit with high costs, we further evaluated the cost-effectiveness of apatinib for patients with chemotherapy-refractory aGC.
  
  
  METHODS
  A Markov model was developed to simulate the disease process of aGC (PFS, progressive disease, and death) and estimate the incremental cost-effectiveness ratio (ICER) of apatinib to placebo. The health outcomes and utility scores were derived from the phase III trial and previously published sources, respectively. Total costs were calculated from the perspective of the Chinese health-care payer. Sensitivity analysis was used to explore model uncertainties.
  
  
  RESULTS
  Treatment with apatinib was estimated to provide an incremental 0.09 quality-adjusted life years (QALYs) at an incremental cost of $8113.86 compared with placebo, which resulted in an ICER of $90,154.00 per QALY. Sensitivity analysis showed that across the wide variation of parameters, the ICER exceeded the willingness-to-pay threshold of $23,700.00 per QALY which was three times the Gross Domestic Product per Capita in China.
  
  
  CONCLUSIONS
  Apatinib is not a cost-effective option for patients with aGC who experienced failure of at least two lines chemotherapy in China. However, for its positive clinical value and subliminal demand, apatinib can provide a new therapeutic option.
authors: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.
authors: Hong-Dou
authors: HD
authors: Chen
authors: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.
authors: Jing
authors: J
authors: Zhou
authors: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.
authors: Feng
authors: F
authors: Wen
authors: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.
authors: Peng-Fei
authors: PF
authors: Zhang
authors: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.
authors: Ke-Xun
authors: KX
authors: Zhou
authors: West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.|Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
authors: Han-Rui
authors: HR
authors: Zheng
authors: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. yangyuflying@hotmail.com.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China. yangyuflying@hotmail.com.
authors: Yu
authors: Y
authors: Yang
authors: Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. fbqiu9@163.com.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China. fbqiu9@163.com.
authors: Qiu
authors: Q
authors: Li
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008390:Markov Chains; D009010:Monte Carlo Method; D011725:Pyridines / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011725:Pyridines; C553458:apatinib
keywords: Advanced gastric cancer; Apatinib; Cost-effectiveness; Third-line treatment