OBJECTIVES: The study aims to systematically review the efficacy, safety and cost-effectiveness of trastuzumab in metastatic gastric cancer treatment in China. METHODS: A systematic review method was performed. We collected both national and international clinical, cost-effectiveness and disease burden studies mainly from database of Pubmed, MEDLINE, CNKI, etc. And health insurance status of trastuzumab in China was also collected. RESULTS: With inclusion and exclusion criteria, there were 8 clinical studies, 2 cost-effectiveness study and 19 disease burden studies finally recruited for the analysis. Clinical results showed that trastuzumab in combination with chemotherapy were effective and well tolerated in target population. In ToGA, the only phase III randomized controlled trial, compared with chemotherapy alone, trastuzumab plus chemotherapy substantially improved overall survival (13.8 vs. 11.1 months) and progression-free survival (6.7 vs. 5.5 months). One cost effectiveness study revealed that from the perspective of UK NHS, ICER of trastuzumab plus chemotherapy among IHC3+ or IHC2+/FISH+ patients was 66,982-71,637 pounds per QALY, compared with chemotherapy alone. Gastric cancer had brought a heavy disease burden to China. The DALY lost from gastric cancer was 1.48-5.03 per thousand patients and average hospitalization expenditure per patient was rising. By the first half year of 2013, there were more than 6 provinces and cities in China providing public reimbursement for trastuzumab, but only 2 for gastric cancer indication. CONCLUSIONS: Trastuzumab with chemotherapy can be considered as a new standard option for HER2-positive metastatic gastric cancer patients. However, more evidences on efficacy, safety and cost effectiveness of trastuzumab are still needed to support local public decision making on health insurance benefits update in China.