ArticlePharmacoEconomics - open2026
Comparative Cost-Effectiveness Analysis of Multiple First-Line Treatments for HER2-Negative Unresectable Advanced or Recurrent Gastric Cancer in Japan.
Article in PharmacoEconomics - open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND/
objectiveHER2-negative unresectable advanced or recurrent gastric cancer (GC) has a poor prognosis. This study evaluated the comparative cost-effectiveness of multiple first-line treatment options from the Japanese healthcare payer perspective.
methodsA partitioned survival model was developed to estimate the cost-effectiveness of each regimen. Hazard ratios were derived from a network meta-analysis to project long-term costs and quality-adjusted life years (QALYs) gained. Regimens included pembrolizumab plus chemotherapy (Pem + Chemo); zolbetuximab plus chemotherapy (Zolb + Chemo); nivolumab plus chemotherapy (NIVO + Chemo); 5-fluorouracil, oxaliplatin, and levofolinate (FOLFOX); capecitabine and oxaliplatin (CapeOx); S-1 and oxaliplatin (SOX), capecitabine and cisplatin (Cape + CDDP); and S-1 and cisplatin (S-1 + CDDP). Cost parameters were obtained from a Japanese medical claims database. Incremental cost-effectiveness ratios (ICERs) were calculated for each regimen. Sensitivity analyses were conducted to assess parameter uncertainty. Scenario analysis was conducted by incorporating tislelizumab, which is approved and recommended in countries outside Japan.
resultsOn the basis of the base-case analysis, CapeOx, SOX, Pem + Chemo (5-FU + CDDP, CapeOx), and Zolb + CapeOx were located on the efficiency frontier. The ICER of SOX versus CapeOx was USD 85,649/QALY. Pem + Chemo versus SOX had an ICER of USD 345,103/QALY. Zolb + CapeOx versus Pem + Chemo had an ICER of USD 1,637,571/QALY. Probabilistic sensitivity analysis showed SOX had the highest probability (40.33%) of being the most cost-effective.
conclusionsAt a willingness-to-pay threshold of USD 100,000/QALY (Japan's HTA upper reference), SOX was identified as the most cost-effective first-line treatment for HER2-negative unresectable advanced or recurrent GC in Japan.
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