Cost-effectiveness analysis of chemotherapy for advanced gastric cancer in China

doi:10.3748/wjg.14.2715

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May 7, 2008 (publication date) through Jan 11, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Gastric Cancer

World J Gastroenterol. May 7, 2008; 14(17): 2715-2722
Published online May 7, 2008. doi: 10.3748/wjg.14.2715

Table 1 General information obtained from the included studies

Study and publication (yr)	Area of China	Design	Sample	Weight (%)	Regimens		Staging				Operation	Outcome measures		Median follow-up period
Study and publication (yr)	Area of China	Design	Sample	Weight (%)	Regimens		I	II	III	IV	Operation	Effectiveness	Economics	Median follow-up period
Dong[5]	Western-northern	Case-control study	44	5.8	Two cycles at least, and 3-4 wk for one cycle.	FAM	0	7	9	0	UR	(1) CR+PR (WHO tumor response criteria) (2) Median survival time	DMC contained: (1) Drugs (2) Tests (3) Treatment for ADR	UR
						EAP	0	5	6	2
						ELF	0	10	4	1
Yu[6]	Eastern-southern	Case-control study	41	5.4	Four cycles totally, and 28 d for one cycle.	FAM	0	0	5	10	None	(1) CR+PR (WHO tumor response criteria) (2) Median survival time	DMC contained: (1) Drugs (2) Treatment for ADR	UR
						EAP	0	0	3	8
						ELF	0	0	5	9
Ding[7]	Eastern-southern	Case-control study	49	6.4	Two cycles at least, and 3-4 wk for one cycle.	FAM	0	1	8	9	None	(1) CR+PR (WHO tumor response criteria) (2) Median survival time	DMC contained: (1) Drugs (2) Treatment for ADR	UR
						EAP	0	1	5	9
						ELF	0	2	8	6
Qian[8]	Eastern-southern	Case-control study	226	29.7	Two cycles at least, and 3 wk for one cycle.	FAM	Almost composed of stage IV as reported.				Unresectable disease, or palliative operation, or recurrence/metastases after curative operation.	(1) CR+PR (WHO tumor response criteria) (2) Median survival time	DMC contained: (1) Drugs (2) Treatment (3) Fee for berth	UR
						UFTM
						FEP
						LFP/M
Yang[9]	Eastern-northern	Case-control study	256	33.7	Three cycles at least, and 3 wk for one cycle.	FAMTX	All unresectable newly diagnosed patients.				None	(1) CR+PR (2) Median survival time	DMC contained: (1) Drugs (2) Treatment for ADR	26.9 mo
Yang[9]	Eastern-northern	Case-control study	256	33.7	Three cycles at least, and 3 wk for one cycle.	ECF	All unresectable newly diagnosed patients.				None	(1) CR+PR (2) Median survival time	DMC contained: (1) Drugs (2) Treatment for ADR	26.9 mo
Zhou[10]	Eastern-southern	Case-control study	48	6.3	Two cycles at least, and 4 wk for one cycle.	TCF	UR				UR	(1) CR+PR (WHO tumor response criteria) (2) Time-to-progression	DMC contained: (1) Drugs (2) Tests (3) Treatment	UR
Zhou[10]	Eastern-southern	Case-control study	48	6.3	Two cycles at least, and 4 wk for one cycle.	FOLFOX	UR				UR		DMC contained: (1) Drugs (2) Tests (3) Treatment	UR
Liu[11]	Eastern-southern	Case-control study	96	12.6	All six cycles.	DCF	0	0	30	2	UR	CR+PR (Chinese association of gastric cancer response criteria)	DMC contained: (1) Drugs (2) Treatment (3) Fee for berth	UR
						ECF	0	0	29	1
						FOLFOX	0	0	31	3

CR: Complete response; PR: Partial response; DMC: Per capita direct medical cost of single cycle; 5FU: 5-fluorouracil; ADM: Adriamycin; EPI: Epirubicin; MMC: Mitomycin; DDP: Cisplatin; VP-16: Etoposide; CF: Calcium Leucovorin; UFT: Uracil-tegafur; MTX: Methotrexate; PTX: Paclitaxel; DXL: Docetaxel; L-OHP: Oxaliplatin; UR: Unretrieved data; FAM: 5FU+ADM/EPI+MMC; EAP: DDP+VP-16+ADM/EPI; ELF: 5FU+VP-16+CF; UFTM: UFT+MMC; LFP/M: 5FU+CF+DDP+MMC; FAMTX: 5FU+CF+ADM+MTX; ECF: 5FU+EPI+DDP; TCF: 5FU+DDP+PTX; FOLFOX: 5FU+CF+L-OHP; DCF: 5FU+CF+DXL+DDP.

Table 2 Primary data retrieved from literatures

Regimens studies	N	CR+PR		MST	DMC
		n	%	(mo)	(￥, RMB)
5FU+ADM/EPI+MMC (FAM)
Dong[5]	16	7	43.8	6.0	2439.78
Yu[6]	15	6	40.0	13.5	1965.00
Ding[7]	18	7	38.9	11.5	1888.50
Qian[8]	35	12	34.3	11.5	1509.78
DDP+VP-16+ADM/EPI (EAP)
Dong[5]	13	7	53.8	8.0	2952.42
Yu[6]	12	6	50.0	9.0	2705.00
Ding[7]	15	8	53.3	8.5	2170.00
5FU+VP-16+CF (ELF)
Dong[5]	15	7	46.7	9.0	3823.05
Yu[6]	14	8	57.1	13.0	1640.00
Ding[7]	1	9	56.3	13.0	1602.00
UFT+MMC (UFTM)
Qian[8]	49	16	32.6	8.5	2322.80
UFT+DDP+VP-16 (FEP)
Qian[8]	51	24	47.9	10.0	1902.90
5FU+CF+DDP+MMC (LFP/M)
Qian[8]	91	40	44.0	9.0	2907.76
5FU+CF+ADM+MTX (FAMTX)
Yang[9]	UR	UR	21.0	6.1	1705.28
5FU+EPI+DDP (ECF)
Yang[9]	UR	UR	46.0	8.7	1526.67
Liu[11]	30	12	40.0	UR	4158.00
5FU+DDP+PTX (TCF)
Zhou[10]	22	11	50.0	UR	2640.60
5FU+CF+DXL+DDP (DCF)
Liu[11]	32	18	56.3	UR	9979.00
5FU+CF+L-OHP (FOLFOX)
Zhou[10]	26	12	46.1	UR	1588.99
Liu[11]	34	18	52.9	UR	4498.00

CR: Complete response; PR: Partial response; MST: Median survival time; DMC: Per capita direct medical cost of single cycle; 5FU: 5-fluorouracil; ADM: Adriamycin; EPI: Epirubicin; MMC: Mitomycin; DDP: Cisplatin; VP-16: Etoposide; CF: Calcium Leucovorin; UFT: Uracil-tegafur; MTX: Methotrexate; PTX: Paclitaxel; DXL: Docetaxel; L-OHP: Oxaliplatin; UR: Unretrieved data.

Table 3 Accumulated and synthesized data

Regimens	Accumulated	Synthesized	Accumulated	Synthesized
	n	MST (mo)	CR+PR (%)	DMC¹ (￥, RMB)
5FU+ADM/EPI+MMC (FAM)	84	10.8	38.1	1978.23
5FU+VP-16+CF(ELF)	45	11.7	53.3	2543.12
5FU+CF+DDP+MMC (LFP/M)	91	9.0	44.0	3056.08
5FU+CF+ADM+MTX (FAMTX)	UR	6.1	21.0	1756.95
5FU+EPI+DDP (ECF)	UR	8.7	44.4²	2276.43²
5FU+DDP+PTX (TCF)	22	UR	50.0	2667.01
5FU+CF+DXL+DDP (DCF)	32	UR	56.3	9979.00
5FU+CF+L-OHP (FOLFOX)	60	UR	50.0	3244.31
UFT+MMC (UFTM)	49	8.5	32.7	2441.29
UFT+DDP+VP-16(FEP)	51	10.0	47.1	1999.97
DDP+VP-16+ADM/EPI (EAP)	40	8.5	52.5	2790.23

¹All the cost data were converted to 2007 price by preset discount rate (1%);

²The data were synthesized by giving the weights equal to those of the studies (Table 1). CR: Complete response; PR: Partial response; MST: Median survival time; DMC: Per capita direct medical cost of single cycle; 5FU: 5-fluorouracil; ADM: Adriamycin; EPI: Epirubicin; MMC: Mitomycin; DDP: Cisplatin; VP-16: Etoposide; CF: Calcium Leucovorin; UFT: Uracil-tegafur; MTX: Methotrexate; PTX: Paclitaxel; DXL: Docetaxel; L-OHP: Oxaliplatin; UR: Unretrieved data.

Table 4 Direct medical cost-effectiveness analyses

Regimens	Cost (￥, RMB)	Incr cost (￥, RMB)	Eff	Incr Eff	C/E (￥, RMB)	Incr C/E (ICER) (￥, RMB)
DMC/MST analyses
5Fu+CF+ADM+MTX (FAMTX)¹	1756.95	-	6.1	-	288.02	Baseline
5Fu+ADM/EPI+MMC (FAM)	1978.23	221.28	10.8	4.7	183.17	47.08
UFT+DDP+VP-16 (FEP)	1999.97	21.74	10.0	-0.8	200.00	Dominated
5Fu+EPI+DDP (ECF)	2276.43	298.20	8.7	-2.1	261.66	Dominated
UFT+MMC (UFTM)	2441.29	463.06	8.5	-2.3	287.21	Dominated
5Fu+VP-16+CF (ELF)	2543.12	564.89	11.7	0.9	217.36	627.66
DDP+VP-16+ADM/EPI (EAP)	2790.23	247.11	8.5	-3.2	328.26	Dominated
5FU+CF+DDP+MMC (LFP/M)	3056.08	512.96	9.0	-2.7	339.56	Dominated
DMC/CR+PR analyses
5Fu+CF+ADM+MTX (FAMTX)¹	1756.95	-	21.0	-	83.66	Baseline
5Fu+ADM/EPI+MMC (FAM)	1978.23	221.28	38.1	17.1	51.92	Extended dominance
UFT+DDP+VP-16 (FEP)	1999.97	21.74	47.1	9	42.46	2.42
5Fu+EPI+DDP (ECF)	2276.43	276.46	44.4	-2.7	51.27	Dominated
UFT+MMC (UFTM)	2441.29	441.32	32.7	-14.4	74.66	Dominated
5Fu+VP-16+CF (ELF)	2543.12	543.15	53.3	6.2	47.71	87.6
5FU+DDP+PTX (TCF)	2667.01	123.89	50.0	-3.3	53.34	Dominated
DDP+VP-16+ADM/EPI (EAP)	2790.23	247.11	52.5	-0.8	53.15	Dominated
5FU+CF+DDP+MMC (LFP/M)	3056.08	512.96	44.0	-9.3	69.46	Dominated
5FU+CF+L-OHP (FOLFOX)	3244.31	701.19	50.0	-3.3	64.89	Dominated
5FU+CF+DXL+DDP (DCF)	9979.00	7435.88	56.3	3.0	177.25	2478.63

¹FAMTX regimen was selected as the common baseline for other regimens to refer to. Incr cost: Incremental cost; Eff: Effectiveness; Incr Eff: Incremental effectiveness; CR: Complete response; PR: Partial response; MST: Median survival time; DMC: Per capita direct medical cost of single cycle; 5FU: 5-fluorouracil; ADM: Adriamycin; EPI: Epirubicin; MMC: Mitomycin; DDP: Cisplatin; VP-16: Etoposide; CF: Calcium Leucovorin; UFT: Uracil-tegafur; MTX: Methotrexate; PTX: Paclitaxel; DXL: Docetaxel; L-OHP: Oxaliplatin.

Table 5 Sensitivity analyses by excluding the studies with a potential heterogeneity

Regimens	Excluding studies contaminated with stage II diseases			Excluding studies from poorly developing areas of China			Excluding studies published before the last 5 years			Excluding the studies weighted more than 25% of overall sample
	Cost	Eff	ICER	Cost	Eff	ICER	Cost	Eff	ICER	Cost	Eff	ICER
Sensitivity analyses of DMC/MST ratio (RMB/mo)
5FU+ADM/EPI+MMC (FAM)	1749.10¹	12.1	Baseline	1822.06	11.9	DT	-	-	-	2257.82¹	10.3	Baseline
5FU+VP-16+CF (ELF)	1775.88	13.0	29.76	1744.78¹	13.0	Baseline	-	-	-	2543.12	11.7	203.79
5FU+CF+DDP+MMC (LFP/M)	3056.08	9.0	DT	3056.08	9.0	DT	-	-	-	-	-	-
5FU+CF+ADM+MTX (FAMTX)	1756.95	6.1	DT	-	-	-	1756.95¹	6.1	Baseline	-	-	-
5FU+EPI+DDP (ECF)	2276.43	8.7	DT	-	-	-	2276.43	8.7	199.8	-	-	-
5FU+DDP+PTX (TCF)	-	-	-	-	-	-	-	-	-	-	-	-
5FU+CF+DXL+DDP (DCF)	-	-	-	-	-	-	-	-	-	-	-	-
5FU+CF+L-OHP (FOLFOX)	-	-	-	-	-	-	-	-	-	-	-	-
UFT+MMC (UFTM)	2441.29	8.5	DT	2441.29	8.5	DT	-	-	-	-	-	-
UFT+DDP+VP-16 (FEP)	1999.97	10.0	DT	1999.97	10.0	DT	-	-	-	-	-	-
DDP+VP-16+ADM/EPI (EAP)	2929.13	9.0	DT	2594.35	8.7	DT	-	-	-	2790.23	8.5	DT
Sensitivity analyses of DMC/CR+PRratio (RMB/%)
5FU+ADM/EPI+MMC (FAM)	1749.10¹	36.0	Baseline	1822.06	36.8	DT	-	-	-	2257.82¹	40.8	Baseline
5FU+VP-16+CF (ELF)	1775.88	57.1	1.27	1744.78 1	56.7	Baseline	-	-	-	2543.12	53.3	22.82
5FU+CF+DDP+MMC (LFP/M)	3056.08	44.0	DT	3056.08	44.0	DT	-	-	-	-	-	-
5FU+CF+ADM+MTX (FAMTX)	1756.95	21.0	DT	-	-	-	1756.95¹	21.0	Baseline	-	-	-
5FU+EPI+DDP (ECF)	2276.43	44.4	DT	4158.00	40.0	DT	2276.43	44.4	22.2	4158.00	40	DT
5FU+DDP+PTX (TCF)	2667.01	50.0	DT	2667.01	50.0	DT	2667.01	50.0	69.75	2667.01	50	DT
5FU+CF+DXL+DDP (DCF)	9979.00	56.3	DT	9979.00	56.3	DT	9979.00	56.3	1160.63	9979.00	56.3	2478.63
5FU+CF+L-OHP (FOLFOX)	3244.31	50.0	DT	3244.31	50.0	DT	3244.31	50.0	DT	3244.31	50	DT
UFT+MMC (UFTM)	2441.29	32.7	DT	2441.29	32.7	DT	-	-	-	-	-	-
UFT+DDP+VP-16 (FEP)	1999.97	47.1	DT	1999.97	47.1	DT	-	-	-	-	-	-
DDP+VP-16+ADM/EPI (EAP)	2929.13	50.0	DT	2594.35	51.9	DT	-	-	-	2790.23	52.5	DT

¹The regimen with the lowest direct medical cost in a single cycle was selected as the common baseline for other regimens to refer to. Eff: Effectiveness; ICER: Incremental cost/effectiveness ratio; CR: Complete response; PR: Partial response; MST: Median survival time; DMC: Per capita direct medical cost of single cycle; DT: Dominated by just the less costly one; 5FU: 5-fluorouracil; ADM: Adriamycin; EPI: Epirubicin; MMC: Mitomycin; DDP: Cisplatin; VP-16: Etoposide; CF: Calcium Leucovorin; UFT: Uracil-tegafur; MTX: Methotrexate; PTX: Paclitaxel; DXL: Docetaxel; L-OHP: Oxaliplatin.

Citation: Chen XZ, Jiang K, Hu JK, Zhang B, Gou HF, Yang K, Chen ZX, Chen JP. Cost-effectiveness analysis of chemotherapy for advanced gastric cancer in China. World J Gastroenterol 2008; 14(17): 2715-2722
URL: https://www.wjgnet.com/1007-9327/full/v14/i17/2715.htm
DOI: https://dx.doi.org/10.3748/wjg.14.2715