Cost-utility analysis of multiple sequential treatment regimens for HER-2 positive advanced gastric cancer

LIU Nana; GUAN Xin; HU Xia

doi:10.6039/j.issn.1001-0408.2025.13.13

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Cost-utility analysis of multiple sequential treatment regimens for HER-2 positive advanced gastric cancer

更新时间：2025-09-24

- Cost-utility analysis of multiple sequential treatment regimens for HER-2 positive advanced gastric cancer
- ZHONGGUO YAOFANG Vol. 36, Issue 13, Pages: 1629-1634(2025)
- 作者机构：
  
  中国药科大学国际医药商学院，南京　211198
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.13.13
  CLC： R956;R735.2
- Received：23 December 2024，
  
  Revised：2025-06-18，
  
  Accepted：21 June 2025，
  
  Published：15 July 2025
- 稿件说明：
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刘娜娜,管欣,胡霞.HER-2阳性晚期胃癌多种序贯治疗方案的成本-效用分析[J].中国药房,2025,36(13):1629-1634.

LIU Nana,GUAN Xin,HU Xia.Cost-utility analysis of multiple sequential treatment regimens for HER-2 positive advanced gastric cancer[J].ZHONGGUO YAOFANG,2025,36(13):1629-1634.
刘娜娜,管欣,胡霞.HER-2阳性晚期胃癌多种序贯治疗方案的成本-效用分析[J].中国药房,2025,36(13):1629-1634. DOI： 10.6039/j.issn.1001-0408.2025.13.13.

LIU Nana,GUAN Xin,HU Xia.Cost-utility analysis of multiple sequential treatment regimens for HER-2 positive advanced gastric cancer[J].ZHONGGUO YAOFANG,2025,36(13):1629-1634. DOI： 10.6039/j.issn.1001-0408.2025.13.13.

摘要

目的

从中国卫生体系的角度，评估不同序贯治疗方案治疗人表皮生长因子受体2（HER-2）阳性晚期胃癌的经济性。

方法

从ToGA、WJOG 4007和RAINBOW-Asia试验中获取生存数据，采用网状Meta分析进行调整。构建四状态Markov模型评估6种治疗序列的经济性，模拟时限为终身，循环周期为4周（28 d），模型的主要输出参数包括总成本、质量调整生命年（QALY）和增量成本-效果比（ICER）。通过敏感性分析检验基础分析结果的稳健性，并对曲妥珠单抗进行降价情境分析。

结果

相比化疗序贯紫杉醇，曲妥珠单抗联合化疗序贯紫杉醇或伊立替康或雷莫西尤单抗联合紫杉醇的ICER分别为349 845.25、772 410.64、2 510 470.39元/QALY，均超过3倍我国2023年人均国内生产总值（GDP）作为的意愿支付（WTP）阈值（268 074元/QALY），显示化疗序贯紫杉醇方案为最优治疗方案。敏感性分析结果证明了基础分析结果的稳健性。情境分析结果表明，当曲妥珠单抗降价幅度大于20%时，在本研究的WTP阈值下，曲妥珠单抗联合化疗序贯紫杉醇方案开始具有经济性。

结论

在以3倍我国2023年人均GDP作为WTP阈值时，化疗序贯紫杉醇是治疗HER-2阳性晚期胃癌的最优方案，曲妥珠单抗联合化疗序贯紫杉醇为次优方案。随着医保政策优化力度的增大，曲妥珠单抗联合化疗序贯紫杉醇有望成为最具经济性的治疗方案。

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of different sequential treatment regimens for human epidermal growth factor receptor 2 （HER-2）-positive advanced gastric cancer from the perspective of the Chinese health system.

METHODS

Survival data were obtained from the ToGA， WJOG 4007 and RAINBOW-Asia trials， and adjusted using network meta-analysis. A four-state Markov model was constructed to evaluate the cost-effectiveness of six treatment sequences， with a lifetime simulation horizon and a cycle period of 4 weeks （28 d）， and the main output parameters of the model included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analysis was conducted to test the robustness of the basic analysis results， and a price reduction scenario analysis for trastuzumab was performed.

RESULTS

Compared with chemotherapy sequentially treated with paclitaxel， the ICER of trastuzumab combined with chemotherapy sequentially treated with paclitaxel， or irinotecan， or ramucirumab plus paclitaxel were 349 845.25， 772 410.64， and 2 510 470.39 yuan/QALY， respectively， all exceeding three times China’s 2023 per capita gross domestic product （GDP）（268 074 yuan/QALY） as the willingness-to-pay （WTP） threshold. This indicated that chemotherapy sequential paclitaxel was the optimal treatment regimen. The sensitivity analysis confirmed the robustness of the basic analysis. The scenario analysis showed that when trastuzumab was reduced by more than 20%， trastuzumab combined with chemotherapy sequentially treated with paclitaxel became cost-effective under this study’s WTP threshold.

CONCLUSIONS

When using three times China’s 2023 per capita GDP as the WTP threshold， chemotherapy sequentially treated with paclitaxel is the optimal regimen for HER-2 positive advanced gastric cancer， with trastuzumab combined with chemotherapy sequentially treated with paclitaxel as the second best option. With enhanced medical insurance optimization， trastuzumab combined with chemotherapy sequentially treated with paclitaxel is expected to become the most cost-effective treatment regimen.

关键词

Keywords

references

ZHENG R S ， CHEN R ， HAN B F ， et al . Cancer incidence and mortality in China，2022 [J ] . Chin J Oncol ， 2024 ， 46 （ 3 ）： 221 - 231 .

赫捷，陈万青，李兆申，等 . 中国胃癌筛查与早诊早治指南：2022，北京 [J ] . 中国肿瘤， 2022 ， 31 （ 7 ）： 488 - 527 .

JØRGENSEN J T ， HERSOM M . HER2 as a prognostic marker in gastric cancer：a systematic analysis of data from the literature [J ] . J Cancer ， 2012 ， 3 ： 137 - 144 .

LI S N ， PENG L B ， TAN C Q ， et al . Cost-effectiveness of ramucirumab plus paclitaxel as a second-line therapy for advanced gastric or gastro-oesophageal cancer in China [J ] . PLoS One ， 2020 ， 15 （ 5 ）： e0232240 .

陈佳，刘卢路，王双梅，等 . 曲妥珠单抗联合化疗治疗HER-2阳性晚期胃癌的成本-效果分析 [J ] . 药物评价研究， 2023 ， 46 （ 6 ）： 1286 - 1292 .

BANG Y J ， VAN CUTSEM E ， FEYEREISLOVA A ， et al . Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer （ToGA）：a phase 3，open-label，randomised controlled trial [J ] . Lancet ， 2010 ， 376 （ 9742 ）： 687 - 697 .

HIRONAKA S ， UEDA S ， YASUI H ， et al . Randomized，open-label，phase Ⅲ study comparing irinotecan with paclitaxel in patients with advanced gastric cancer without severe peritoneal metastasis after failure of prior combination chemotherapy using fluoropyrimidine plus platinum：WJOG 4007 trial [J ] . J Clin Oncol ， 2013 ， 31 （ 35 ）： 4438 - 4444 .

XU R H ， ZHANG Y Q ， PAN H M ， et al . Efficacy and safety of weekly paclitaxel with or without ramucirumab as second-line therapy for the treatment of advanced gastric or gastroesophageal junction adenocarcinoma （RAINBOW-Asia）：a randomised，multicentre，double-blind，phase 3 trial [J ] . Lancet Gastroenterol Hepatol ， 2021 ， 6 （ 12 ）： 1015 - 1024 .

刘国恩 . 中国药物经济学评价指南2020 [M ] . 北京：中国市场出版社， 2020 ：4- 5 ， 19 ， 27 - 28 .

ZHAO M Y ， SHAO T H ， CHI Z Y ， et al . Effectiveness and cost-effectiveness analysis of 11 treatment paths，seven first-line and three second-line treatments for Chinese patients with advanced wild-type squamous non-small cell lung cancer：a sequential model [J ] . Front Public Health ， 2023 ， 11 ： 1051484 .

SHERROW C ， ATTWOOD K ， ZHOU K H ， et al . Sequencing systemic therapy pathways for advanced hepatocellular carcinoma：a cost effectiveness analysis [J ] . Liver Cancer ， 2020 ， 9 （ 5 ）： 549 - 562 .

周挺，马爱霞 . 生存分析在药物经济学评价Markov模型转移概率计算中的应用 [J ] . 中国循证医学杂志， 2018 ， 18 （ 10 ）： 1129 - 1134 .

QIAO L ， ZHOU Z ， ZENG X H ， et al . Cost-effectiveness of domestic PD-1 inhibitor camrelizumab combined with chemotherapy in the first-line treatment of advanced nonsquamous non-small-cell lung cancer in China [J ] . Front Pharmacol ， 2021 ， 12 ： 728440 .

WU B ， LI T ， CAI J ， et al . Cost-effectiveness analysis of adjuvant chemotherapies in patients presenting with gastric cancer after D2 gastrectomy [J ] . BMC Cancer ， 2014 ， 14 ： 984 .

WEN F ， ZHENG H R ， ZHANG P F ， et al . Atezolizumab and bevacizumab combination compared with sorafenib as the first-line systemic treatment for patients with unresec- table hepatocellular carcinoma：a cost-effectiveness analysis in China and the United States [J ] . Liver Int ， 2021 ， 41 （ 5 ）： 1097 - 1104 .

CHEN J ， HU G Y ， CHEN Z ， et al . Cost-effectiveness analysis of pembrolizumab plus axitinib versus sunitinib in first-line advanced renal cell carcinoma in China [J ] . Clin Drug Investig ， 2019 ， 39 （ 10 ）： 931 - 938 .

ZHANG P F ， XIE D ， LI Q . Cost-effectiveness analysis of nivolumab in the second-line treatment for advanced esophageal squamous cell carcinoma [J ] . Future Oncol ， 2020 ， 16 （ 17 ）： 1189 - 1198 .

赵婧雨，金冠一，杨莉 . 达可替尼一线治疗表皮生长因子突变阳性非小细胞肺癌的成本-效用分析 [J ] . 中国药物经济学， 2021 ， 16 （ 1 ）： 20 - 26 .

TSUCHIYA A ， IKEDA S ， IKEGAMI N ， et al . Estimating an EQ-5D population value set：the case of Japan [J ] . Health Econ ， 2002 ， 11 （ 4 ）： 341 - 353 .

National Institute for Health and Care Excellence . NICE （ 2010 ） Technology Appraisal Guidance 208：trastuzumab for the treatment of HER2-positive metastatic gastric cancer [M ] . London ： National Institute for Health and Clinical Excellence ，2010： 38 .

刘雪丽，郑丽英，宋佳芳，等 . 心血管病高危及以上风险患者使用氨氯地平阿托伐他汀钙片的成本-效果分析 [J ] . 中国药物经济学， 2019 ， 14 （ 8 ）： 19 - 25，54 .

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