Apatinib for chemotherapy-refractory advanced metastatic gastric cancer: A cost-effective analysis compared with conventional chemotherapy.

Abstract

e15531 Background: Apatinib can improve survival in patients with metastatic gastric cancer (mGC) who do not respond to or who experience progression with second-line chemotherapy. Apatinib Patient Assistance Program (PAP) is implemented for Chinese patients. A cost-effective analysis is needed for apatinib with PAP. Methods: A Markov model was developed to simulate the clinical course of typical patients with chemotherapy-refractory mGC. We estimated 10-year quality-adjusted life-years (QALY), costs, and incremental cost-effectiveness ratios (ICER). The Clinical efficacy and safety were derived from the pivotal phase II and III trials of apatinib. Direct costs were estimated from the perspective of Chinese health care system. One-way and probabilistic sensitivity analyses were conducted. Scenario analysis for Patient Assistance Program (PAP) was checked. Results: Baseline analysis showed that the apatinib increased the cost and QALYs by $7,859 and 0.191, respectively, relative to conventional chemotherapy, resulting in an ICER of $40,997/QALY gained. The ICER was $21,132/QALY when 3+X PAP (paying for 3 months following free donation until disease progressed) was available. Probabilistic sensitivity analyses confirmed that apatinib with 3+X PAP achieved nearly two 2/3 likelihood of cost-effectiveness under the Chinese willingness-to-pay threshold of $ 22,200 per QALY gained. One-way sensitivity analyses found that the utility of progression-free survival was the most influential factor with respect to the robustness of the model. Budget impact analysis estimated that the annual increase in fiscal expenditures would be approximately 0.45 million dollars. Conclusions: Our analysis suggests that apatinib is likely to be cost-effective in patients with chemotherapy-refractory mGC when 3+X PAP is available.