OBJECTIVES: To provide a reference for setting prices for ramucirumab after approval, marketing and assessment, it is appropriate to include an economic evaluation of ramucirumab for previously treated advanced gastric cancer in the health insurance directory in China. METHODS: A Markov model was developed to simulate a cohort of Chinese adults with advanced gastric (GC) or gastro-oesophageal junction (GOJ) adenocarcinoma in whom first-line chemotherapy failed. Transition probabilities were obtained from the REGARD clinical trial, which compared the patients who randomly received the best supportive care plus 8 mg/kg ramucirumab or placebo. Utility values and disease-related costs were obtained from published studies. Robustness and uncertainty were tested using deterministic and probabilistic sensitivity analyses. RESULTS: In China, according to the model base case analysis over 10 years, when ramucirumab cost $0.48/mg, the incremental cost-effectiveness ratio (ICER) approximated the WTP threshold, which was $22,785/QALY in 2014, and when ramucirumab cost $1.17/mg, the ICER was nearly equal ($48,838/QALY) to the WTP threshold of Beijing City. When ramucirumab cost $0.48/mg, the average cost per patient treated with ramucirumab was 29914.89 S$, while that of the placebo was 28091.16 S$. A patient treated with ramucirumab gained an average of extra 0.08 QALYs relative to untreated patients. Therefore, ramucirumab produced an ICER of S$22796.63 per QALY gained relative to placebo when ramucirumab cost $0.48/mg. The most sensitive variable in the cost-effectiveness analysis was the ratio of patients who received third-line chemotherapy in the placebo group. CONCLUSIONS: Our results indicated that as the second-line chemotherapy for advanced GC/GOJ upon failure of first-line chemotherapy, ramucirumab would be a cost-effective option in China only when it costs less than $0.48/mg. It must cost less than $1.17/mg to be a cost-effective option in Beijing City.