Cost-effectiveness of targeted therapy versus chemotherapy for patients with advanced or metastatic gastric cancer in China

This is the authors' abstract. We don't add key points for this paper.

Background Multi-biomarker testing increasingly guides first-line therapy for advanced or metastatic gastric cancer in China, but its economic value is uncertain. Methods We conducted a Chinese healthcare payer–perspective cost-effectiveness analysis comparing a testing-guided pathway with No-testing, using a hybrid decision tree plus three-state Markov model for a 1,000-patient cohort over 10 years. Results Testing-guided care increased costs by $64,242.13 and quality-adjusted life years (QALYs) by 0.63, yielding an incremental cost-effectiveness ratio (ICER) of $101,278.5/QALY and failing to meet the willingness to pay (WTP) threshold. Probabilistic sensitivity analysis (PSA) showed 0% probability of cost-effectiveness at $40,629/QALY; key one-way drivers included progression-free (PF) utility and zolbetuximab cost. Conclusions Biomarker-guided treatment improved outcomes but was not cost-effective in China at current prices, mainly due to high drug costs in large biomarker-defined groups. Value-based pricing may improve affordability and cost-effectiveness.