Gastric cancer, one of the deadliest cancer types globally, continues to challenge medical practitioners and patients, particularly when human epidermal growth factor receptor 2 (HER2)-positive. The aggressive nature of HER2-positive gastric or gastroesophageal junction adenocarcinoma necessitates innovative treatment combinations, and the KEYNOTE-811 phase III trial emerged as a beacon of hope. It demonstrated significant clinical outcome enhancements with the use of pembrolizumab, trastuzumab, and chemotherapy (PTC) compared to the traditional trastuzumab and chemotherapy (TC). However, translating these clinical successes into economic terms remains a complex puzzle. This study aims to navigate this economic landscape by assessing the cost-effectiveness of the PTC regimen within the United States, leveraging a comprehensive model-based pharmacoeconomic evaluation.
Study Objectives and Methods
The study’s primary objective was to evaluate the cost-effectiveness of the PTC regimen versus the TC regimen for patients battling unresectable metastatic HER2-positive G/GEJ adenocarcinoma. Researchers utilized a sophisticated 10-year semi-Markov model to project disease progression and costs, integrating real-world data for precision. Additionally, the assessment involved evaluating sequential treatment strategies, considering variations in PD-L1 combined positive score (CPS).
Detailed Results
Key findings revealed that for patients with PD-L1 CPS greater than 341, PTC provided an incremental benefit of 0.33 quality-adjusted life years (QALYs) at an extra cost of $247,474.27, culminating in an incremental cost-effectiveness ratio (ICER) of $750,750.50 per QALY. This figure starkly contrasts with the U.S. willingness-to-pay threshold of $150,000/QALY, underscoring the financial burden of this regimen. Other patient cohorts, including those with CPS less than 1 and the general population, exhibited similarly unsustainable ICERs, highlighting the economic challenges faced by PTC regimens.
– The PTC regimen presents very high costs compared to TC, especially in the U.S. healthcare context.
– Patients with higher PD-L1 scores do not derive sufficient economic benefit from PTC.
– Sequential treatment strategies continue to favor cost-effectiveness for TC-based approaches.
– Model robustness solidified through extensive sensitivity analyses.
The study concluded that, from a U.S. payer standpoint, PTC regimens are financially inefficient for treating HER2-positive metastatic G/GEJ adenocarcinoma, irrespective of PD-L1 CPS status. To bolster this economic equation, stakeholders should consider price reduction pathways and the refinement of biomarker-driven therapeutic strategies, aligning with precision medicine’s guiding principles. For stakeholders in the healthcare sector, the findings underscore the urgent need to explore economic strategies that align with clinical advancements and actual payment capabilities. In the grand scheme, incorporating cost into cancer treatment discussions becomes as pivotal as clinical efficacy itself, prompting a shift towards more sustainable healthcare solutions.
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