G. Hua1, E. Joseph3, C. McLaughin4, C.J. Allen5 1Drexel University College Of Medicine, Philadelphia, PA, USA 3Allegheny Health Network, Singer Research Institute, Pittsburgh, PA, USA 4Lake Erie College of Osteopathic Medicine, Erie, PA, USA 5Allegheny Health Network, Institute Of Surgery, Division Of Surgical Oncology, Pittsburgh, PA, USA
Introduction:
Gastric cancer remains a significant financial burden on healthcare spending. As we focus on the delivery of value-based care, there is a need to understand the costs associated with novel gastric cancer treatments. Our study evaluates the cost-effectiveness of the three novel therapies recently approved by the FDA for metastatic gastric cancer.
Methods:
We analyzed the cost-effectiveness of therapies approved by the FDA between 2021 and 2023—pembrolizumab, nivolumab, and trastuzumab deruxtecan. To calculate the amount of therapy used, duration of therapy and therapy regimens were obtained from the clinical trials used by the FDA for approval (KEYNOTE-859, CHECKMATE-649, DESTINY-Gastric01). Drug costs were collected from Medicare and Medicaid Part B average sales price from April 2024. Equal value life years gained (EVLYG) was calculated from the difference in median overall survival. An incremental cost-effectiveness ratio (ICER) was then calculated with the threshold set as $200,000 per EVLYG. In all three trials, two standard chemotherapy regimens are given as options for clinicians to choose from. Calculations are done using both regimens, and all ICER results are evaluated.
Results:
The cost of pembrolizumab with standard chemotherapy treatment was $103,211.14 or $103,424.40, and chemotherapy alone was calculated to cost $822.63 or $1,035.89. The EVLYG of pembrolizumab was 0.12 years, and ICER was calculated to be either $878,733.42/EVLYG or $879,073.53/EVLYG. The cost of nivolumab with standard chemotherapy treatment was calculated to be $102,542.17 or $103,411.57, and chemotherapy alone was calculated to be $1,051.25 or $1,920.75. The EVLYG of nivolumab was 0.17 years, and ICER was calculated to be $610,707.46/EVLYG or $612,164.98/EVLYG. The cost of trastuzumab deruxtecan with chemotherapy was $90,208.18 or $89,978.92. Chemotherapy alone costed $447.80 or $218.54. The EVLYG was 0.34 years, and ICER was calculated to be $ 263,266.16/EVLYG or $262,713.31/EVLYG. All three therapies exceeded the $200,000 threshold.
Conclusion:
In the United States, pembrolizumab, nivolumab, and trastuzumab deruxtecan for treatment of metastatic gastric cancer are not cost-effective. Clinicians will need to consider the financial impact of these treatments when deciding the appropriate treatment option for their patients.