ArticleFrontiers in medicine2026
Cost-effectiveness analysis of pembrolizumab plus trastuzumab and chemotherapy as first-line treatment for HER2-positive gastric or gastroesophageal junction adenocarcinoma.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: The final analysis of KEYNOTE-811 demonstrated that pembrolizumab plus trastuzumab and chemotherapy significantly improved both overall survival (OS) and progression-free survival (PFS) compared to trastuzumab plus chemotherapy alone. Based on these latest findings, this study evaluated the cost-effectiveness of pembrolizumab plus trastuzumab and chemotherapy from the perspective of the Chinese healthcare system.. Design: Using a partitioned survival model, this study compared quality-adjusted life years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs) between pembrolizumab plus trastuzumab and chemotherapy versus trastuzumab plus chemotherapy alone. Efficacy and safety data were derived from KEYNOTE-811, local databases, and relevant literature. To validate the robustness of the model results, sensitivity analyses were conducted. Additionally, subgroup analyses were conducted specifically for the patient population with PD-L1 expression ≥1%.. Interventions: Pembrolizumab plus trastuzumab and chemotherapy. Outcome measures: Total costs, life years, quality adjusted life years (QALYs), incremental QALYs and incremental cost-effectiveness ratio (ICER). Results: In the intention-to-treat (ITT) population, pembrolizumab plus trastuzumab and chemotherapy demonstrated a gain of 0.56 QALYs compared to trastuzumab plus chemotherapy alone, with an additional cost of $322,653.47, resulting in an ICER of $571,997.42/QALY. In the PD-L1 ≥ 1 subgroup, the pembrolizumab combination arm showed a QALY improvement of 0.38, yielding an ICER of $1,178,714.74 per QALY.. Conclusion: From the perspective of Chinese healthcare system, the addition of pembrolizumab to trastuzumab-chemotherapy as first-line therapy failed to demonstrate cost-effectiveness for HER2-positive gastric/gastroesophageal junction adenocarcinoma across both the ITT population and PD-L1 ≥ 1 subgroup.
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