title: Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer.
abstract: OBJECTIVE
  Second-line chemotherapy has been shown to benefit patients with advanced gastric cancer (AGC), extending the overall survival (OS) and progression-free survival (PFS). This study aimed to assess the efficacy and cost-effectiveness of second-line treatment for elderly patients with AGC.
  
  
  METHODS
  Medical records and follow-up information of elderly patients (≥70 years) with AGC who received second-line chemotherapy were collected. A Markov model comprising three health states PFS, progressive disease and death was developed to simulate the process of AGC. Cost was calculated from the perspective of Chinese society. Sensitivity analyses were applied to explore the impact of essential variables.
  
  
  RESULTS
  Forty-three elderly patients with AGC receiving second-line chemotherapy were included in our study. The median OS was 6.0 months (95% confidence interval (CI) 3.90-8.10) and PFS was 3.1 months (95% CI 1.38-4.82). No treatment-related death occurred. The most frequently drug-related grade 3/4 AEs were diarrhea (2.3%), leukopenia (16.3%) and nausea (7.0%). The incremental cost-effective ratio was $18,223.75/QALY for second-line chemotherapy versus BSC, which was below the threshold of 3× the per capita GDP of China, $23,970.00.
  
  
  CONCLUSIONS
  Second-line chemotherapy was an optimal strategy for elderly AGC patients in China from the efficacy and cost-effectiveness perspective.
authors.affiliation: 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.forename: K
authors.initials: K
authors.lastname: Zhou
authors.affiliation: 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.forename: F
authors.initials: F
authors.lastname: Wen
authors.affiliation: 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.forename: P
authors.initials: P
authors.lastname: Zhang
authors.affiliation: 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.forename: J
authors.initials: J
authors.lastname: Zhou
authors.affiliation: 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.forename: H
authors.initials: H
authors.lastname: Chen
authors.affiliation: West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China.|Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: H
authors.initials: H
authors.lastname: Zheng
authors.affiliation: 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.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.affiliation: 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.forename: Q
authors.initials: Q
authors.lastname: Li
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D002681:China; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000191:economics*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality
keywords: Advanced gastric cancer; Cost-effectiveness; Elderly; Second-line chemotherapy