OBJECTIVES:

The objective of this study was to assess the cost-effectiveness of Ramucirumab as add-on therapy to Paclitaxel (RAM+PAC) for patients with GC/GOJs with disease progression or after chemotherapy from health insurance institute (HII) perspective.

METHODS :

The model design adopted a long-term Markov model over a time horizon of 5 years. Patients allocated in the following health states: Preprogression free, Post progression, death, with all patients entering in the preprogression health state. Transition probabilities between the health states were determined from parametric survival functions fitted to the data from the RAINBOW study. The model used a cycle length of 28 day, and a half-cycle correction was applied to all calculations. Direct medical costs were obtained from Tender and MOH hospitals in financial fiscal year 2019 in Egypt. Utility values was were derived from NICE Technology appraisal 2015 [TA378]. Both costs and benefits were discounted at a rate of 3.5%. Deterministic and probabilistic sensitivity analyses were conducted.

RESULTS :

The study revealed that (RAM+PAC) yielded an additional gain of 0.12 QALYs at higher cost estimated by 323819.22 LE than paclitaxel over 5-years ,thus (RAM+PAC) is not cost effective with ICER equal to 2676521 EGP/QALY over 5 years’ time horizon. The deterministic sensitivity analysis showed that cost of Ramucirumab had the greatest impact on the results. A probabilistic sensitivity analysis showed that (RAM+PAC) was with a 100% probability of being above 86,000 EGP / QALY gained.

CONCLUSIONS :

(RAM+PAC) is not cost effective compared to paclitaxel as second-line treatment of locally advanced or metastatic Gastric Cancer or gastro-esophageal junction adenocarcinoma