Cost-effectiveness Analysis of Fluorouracil, Leucovorin, and Irinotecan versus Epirubicin, Cisplatin, and Capecitabine in Patients with Advanced Gastric Adenocarcinoma.
No standard treatment has been accepted widely for the first-/second-line therapy for advanced gastric cancer (AGC). The current study aimed to determine a preferred strategy between FOLFIRI (fluorouracil, leucovorin, and irinotecan) and ECX (epirubicin, cisplatin,and capecitabine) for AGC from the cost-effectiveness perspective. According to a French intergroup study, two groups (ECX arm and FOLFIRI arm) and three health states (progression-free survival (PFS), progressive disease (PD) and death) were analyzed in the current Markov model. All the medical costs were calculated from a Chinese societal perspective. Although FOLFIRI was an acceptable first-line therapy in the treatment of AGC with a better time-to treatment failure (TTF) compared to ECX, ECX arm (ECX followed by FOLFIRI) gained 0.08 quality-adjusted life months (QALMs) more effectiveness benefit compared with FOLFIRI arm (FOLFIRI followed by ECX). Additionally, a lower cost was found in ECX arm ($23,813.13 versus $24,983.70). Hence, the strategy of FOLFIRI arm is dominated by ECX arm ($4,125.8 per QALM in FOLIRI arm; $3,879.724 per QALM in ECX arm). ECX followed by FOLFIRI was a preferred strategy with more effectiveness and lower cost compared with FOLFIRI followed by ECX for the treatment of AGC.
Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China.
Feng
F
Wen
West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China.|Department of Clinical Pharmacy, West China Hospital, Sichuan University, China.
Hanrui
H
Zheng
School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, USA.
Yifan
Y
Wu
School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, USA.
John
J
Wheeler
West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China.|Division of Nephrology of Department of Internal Medicine, West China Hospital, Sichuan University, China.
Xiaoxi
X
Zeng
West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China.|Division of Nephrology of Department of Internal Medicine, West China Hospital, Sichuan University, China.
Ping
P
Fu
Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China.|West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, China.
Qiu
Q
Li
D000230:Adenocarcinoma / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics*; D002681:China; D003362:Cost-Benefit Analysis; D004358:Drug Therapy / Q000191:economics* / Q000379:methods*; D004359:Drug Therapy, Combination / Q000191:economics / Q000379:methods; D006801:Humans; D013274:Stomach Neoplasms / Q000188:drug therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents