THE ECONOMIC IMPACT OF PERIOPERATIVE IMMUNE CHECKPOINT INHIBITORS IN RESECTABLE GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS IN A CANADIAN SETTING
Author(s)
Kimberly Guinan, MSc1, Catherine Royer, B.Sc. Act., ASA1, Karine Mathurin, MSc1, Nikkita Dutta, MSc2, Julia Shen, MSc2, Jean Lachaine, PhD1.
1PeriPharm Inc., Montreal, QC, Canada, 2AstraZeneca Canada, Mississauga, ON, Canada.
1PeriPharm Inc., Montreal, QC, Canada, 2AstraZeneca Canada, Mississauga, ON, Canada.
OBJECTIVES: Perioperative (periop-) FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) is the Canadian standard of care for the treatment of resectable gastric and gastroesophageal junction cancers (GC/GEJC), yet recurrence rates remain high. In the phase 3 MATTERHORN trial (NCT04592913), adding durvalumab to periop-FLOT (periop-DUR+FLOT) significantly improved event-free survival (EFS), representing the first immune checkpoint inhibitor to demonstrate benefit in this setting. Canadian data on healthcare resource utilization (HCRU) and costs in resectable GC/GEJC are limited. This study estimates HCRU and associated costs for periop-DUR+FLOT versus periop-FLOT from a Canadian healthcare and societal perspective.
METHODS: A lifetime cost calculator was developed to compare HCRU of periop-DUR+FLOT versus periop-FLOT in a Canadian setting. From the Canadian healthcare perspective, costs included treatment acquisition, administration, surgery, monitoring, adverse events (AEs), subsequent treatments, and palliative care. A scenario analysis evaluated the societal perspective, incorporating patient and caregiver productivity losses and travel costs. All costs were reported in 2025 Canadian dollars. Clinical inputs (including EFS and overall survival) were informed by the MATTERHORN trial and validated by Canadian clinical experts.
RESULTS: Total per-patient healthcare costs were estimated at $324,145 for periop-DUR+FLOT and $178,939 for periop-FLOT. Periop-DUR+FLOT was associated with reductions in downstream healthcare system costs, including savings of $9,996 in subsequent treatments, $6,969 in palliative care, and $6,525 in monitoring. Periop-DUR+FLOT was also associated with lower AE management costs (-$417). These savings reflected superior efficacy, characterized by fewer EFS events and a greater proportion of patients achieving cure compared with periop-FLOT. Results were consistent when assessed from the societal perspective.
CONCLUSIONS: Despite higher upfront treatment costs, periop-DUR+FLOT was associated with reduced downstream HCRU and related costs in resectable GC/GEJC, driven by superior efficacy with fewer recurrences and reduced subsequent care requirements. These results highlight the broader economic implications of improved perioperative outcomes in this therapeutic setting.
METHODS: A lifetime cost calculator was developed to compare HCRU of periop-DUR+FLOT versus periop-FLOT in a Canadian setting. From the Canadian healthcare perspective, costs included treatment acquisition, administration, surgery, monitoring, adverse events (AEs), subsequent treatments, and palliative care. A scenario analysis evaluated the societal perspective, incorporating patient and caregiver productivity losses and travel costs. All costs were reported in 2025 Canadian dollars. Clinical inputs (including EFS and overall survival) were informed by the MATTERHORN trial and validated by Canadian clinical experts.
RESULTS: Total per-patient healthcare costs were estimated at $324,145 for periop-DUR+FLOT and $178,939 for periop-FLOT. Periop-DUR+FLOT was associated with reductions in downstream healthcare system costs, including savings of $9,996 in subsequent treatments, $6,969 in palliative care, and $6,525 in monitoring. Periop-DUR+FLOT was also associated with lower AE management costs (-$417). These savings reflected superior efficacy, characterized by fewer EFS events and a greater proportion of patients achieving cure compared with periop-FLOT. Results were consistent when assessed from the societal perspective.
CONCLUSIONS: Despite higher upfront treatment costs, periop-DUR+FLOT was associated with reduced downstream HCRU and related costs in resectable GC/GEJC, driven by superior efficacy with fewer recurrences and reduced subsequent care requirements. These results highlight the broader economic implications of improved perioperative outcomes in this therapeutic setting.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE155
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology