COST-EFFECTIVENESS OF SECOND-LINE TREATMENTS FOR ADVANCED AND METASTATIC GASTRIC CANCER IN THE IRISH HEALTHCARE-SETTING
Author(s)
Shikha Sharma, MSc, MSc, PhD1, David McConnell, BA, PhD2, Niamh Carey, BSc, MSc, PharmD, PhD2, Patrick Kearns, BSc, MPH2, Jacintha O'Sullivan, PhD3, Maeve Lowery, MB BCh BAO4, Laura McCullagh, BSc, PhD2.
1RCSI University of Medicine and Health Sciences, Dublin, Ireland, 2National Centre for Pharmacoeconomics, Dublin, Ireland, 3Trinity College Dublin, Dublin 8, Republic of Ireland, Ireland, 4St James's Hospital, Trinity College Dublin, Dublin 8, Republic of Ireland, Ireland.
1RCSI University of Medicine and Health Sciences, Dublin, Ireland, 2National Centre for Pharmacoeconomics, Dublin, Ireland, 3Trinity College Dublin, Dublin 8, Republic of Ireland, Ireland, 4St James's Hospital, Trinity College Dublin, Dublin 8, Republic of Ireland, Ireland.
OBJECTIVES: Over recent years, there have been rapid changes in the treatment landscape for advanced and metastatic gastric cancer in the second- line setting. Notably, the development of immunotherapies and targeted therapies. However, the cost effectiveness of these novel treatments versus more established chemotherapy is uncertain. The objective is to investigate the cost-effectiveness of systemic treatments for the second-line treatment of advanced and metastatic gastric cancer.
METHODS: Treatments of interest were those recommended by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) that could be compared within both overall survival and progression-free survival network meta-analyses. Treatments of interest here were, irinotecan alone, FOLFIRI, ramucirumab + paclitaxel and pembrolizumab alone. Given its widespread use in clinical practice, paclitaxel was prespecified as the benchmark comparator. A partitioned-survival model was developed in R. Relative efficacy inputs for overall survival and progression-free survival were derived from network meta-analyses implemented by the authors (Sharma S et al. Relative Clinical Efficacy and Safety of Second- or Later-Line Treatments for Advanced and Metastatic Gastric Cancer. J Gastrointest Canc 57, 36 (2026)). Survival data was extrapolated to lifetime. Deterministic and probabilistic analyses were undertaken from the perspective of the Irish health payer. Publicly available drug costs were considered. Utility data were sourced via a targeted literature search. A 4% discount rate on outcomes and costs was applied. A €45,000/QALY payer threshold was applied.
RESULTS: None of the treatments of interest were cost effective, versus paclitaxel, at the payer threshold. The probability that irinotecan was cost effective versus paclitaxel was 25%. The probability was 0% for each of the other treatments versus paclitaxel. Utility values were the key drivers.
CONCLUSIONS: There remains a need for novel systematic treatments, for the second-line treatment of advanced and metastatic gastric cancer, that are effective and cost effective versus more established systemic treatments.
METHODS: Treatments of interest were those recommended by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) that could be compared within both overall survival and progression-free survival network meta-analyses. Treatments of interest here were, irinotecan alone, FOLFIRI, ramucirumab + paclitaxel and pembrolizumab alone. Given its widespread use in clinical practice, paclitaxel was prespecified as the benchmark comparator. A partitioned-survival model was developed in R. Relative efficacy inputs for overall survival and progression-free survival were derived from network meta-analyses implemented by the authors (Sharma S et al. Relative Clinical Efficacy and Safety of Second- or Later-Line Treatments for Advanced and Metastatic Gastric Cancer. J Gastrointest Canc 57, 36 (2026)). Survival data was extrapolated to lifetime. Deterministic and probabilistic analyses were undertaken from the perspective of the Irish health payer. Publicly available drug costs were considered. Utility data were sourced via a targeted literature search. A 4% discount rate on outcomes and costs was applied. A €45,000/QALY payer threshold was applied.
RESULTS: None of the treatments of interest were cost effective, versus paclitaxel, at the payer threshold. The probability that irinotecan was cost effective versus paclitaxel was 25%. The probability was 0% for each of the other treatments versus paclitaxel. Utility values were the key drivers.
CONCLUSIONS: There remains a need for novel systematic treatments, for the second-line treatment of advanced and metastatic gastric cancer, that are effective and cost effective versus more established systemic treatments.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE95
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Disease
Gastrointestinal Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Personalized & Precision Medicine, Surgery