Gastric Cancer
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 7, 2008; 14(17): 2715-2722
Published online May 7, 2008. doi: 10.3748/wjg.14.2715
Cost-effectiveness analysis of chemotherapy for advanced gastric cancer in China
Xin-Zu Chen, Kun Jiang, Jian-Kun Hu, Bo Zhang, Hong-Feng Gou, Kun Yang, Zhi-Xin Chen, Jia-Ping Chen
Xin-Zu Chen, Jian-Kun Hu, Bo Zhang, Kun Yang, Zhi-Xin Chen, Jia-Ping Chen, Department of Gastrointestinal Surgery, and Multidisciplinary Treatment Team of Gastrointestinal Tumors, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Kun Jiang, Department of Integrated Western and Traditional Chinese Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Hong-Feng Gou, Department of Oncology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen XZ was responsible for the research design, data extraction and statistics; Jiang K for the literature search, full-text retrieval and data extraction; medical student Yang K for the literature search and full-text retrieval; Gou HF for the result interpretation; Hu JK and Zhang B for the proof of results and manuscript; Chen ZX and Chen JP for the academic instructions.
Correspondence to: Professor Jian-Kun Hu, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guoxuexiang No. 37, Chengdu 610041, Sichuan Province, China.
Telephone: +86-28-85422879
Fax: +86-28-85164035
Received: January 17, 2008
Revised: March 11, 2008
Published online: May 7, 2008

AIM: To assess the economics of various chemotherapeutic regimens for advanced gastric cancer (AGC), and to select the best cost-effective regimen for the common Chinese patients.

METHODS: Data source used in this study was the Chinese Biomedical Disk Database. Patients were diagnosed as AGC and any regimen was eligible. Outcome measures included median survival time (MST) and percentage of complete and partial response (CR+PR). Economic statistics was per capita direct medical cost (DMC) of a single cycle. TreeAge Pro Healthcare 2007 software was used to carry out cost-effectiveness and incremental cost-effectiveness analysis. Sensitivity analyses were applied by altering willingness-to-pay and annual discount rate, and also re-analyzed by excluding the studies with apparent heterogeneity.

RESULTS: Seven retrospective economics studies on 760 patients were included. 5-fluorouracil-based regimens were universal, and also some new agents were involved, such as docetaxel, paclitaxel, and oxaliplatin. By processing analysis, we could recommend etoposide, leucovorin and 5-fluorouracil (ELF) regimen as preference, with a DMC/MST ratio of 2543 RBM/11.7 mo and a DMC/CR+PR ratio of 2543 RMB/53.3%. Uracil-tegafur, etoposide and cisplatin (FEP) or 5-fluorouracil, adrimycin/epirubin and mitomycin (FAM) regimens could be regarded as optional first-line chemotherapy for AGC in common Chinese patients. With no regard for willingness-to-pay, the docetaxel, cisplatin and 5-fluorouracil (DCF) regimen could be chosen as either a first- or a second-line chemotherapy, with a DMC/CR+PR ratio of 9979 RMB/56.3%.

CONCLUSION: 5-fluorouracil regimens are still considered the mainstream for AGC, while new agents such as taxanes are optional. More randomized clinical trials are required before any mandatory recommendation of certain regimens for patients with AGC in China is made.

Keywords: Advanced gastric cancer, Chemotherapy, 5-fluorouracil, Taxanes, Cost-effectiveness