ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1604372
This article is part of the Research TopicAdvancing Health Technology Assessment and Patient-Reported Outcomes: Innovations and Implications for Health Economics and Outcomes ResearchView all 4 articles
Cost-effective Analysis of Sugemalimab plus Chemotherapy as First-Line Treatment for Advanced Gastric or Gastroesophageal Junction Adenocarcinoma with PD-L1 CPS ≥ 5
Provisionally accepted
- 1Mindong Hospital, Fujian Medical University, Ningde, China
- 2Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China, Quanzhou, China
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Background: Results from the GEMSTONE-303 trial indicate that compared with placebo plus capecitabine and oxaliplatin (PLA-CAP), sugemalimab plus capecitabine and oxaliplatin (SUG-CAP) as first-line therapy provides clinical benefits for patients with advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma with programmed cell death ligand 1 (PD-L1) combined positive score (CPS) ≥5. However, the addition of sugemalimab increases medical costs. This study aimed to assess the cost-effectiveness of SUG-CAP versus PLA-CAP for the first-line treatment of advanced G/GEJ adenocarcinoma with PD-L1 CPS ≥5 from the perspective of China's healthcare system.Methods: A Markov model with three health states was developed to compare the cost-effectiveness of SUG-CAP and PLA-CAP. Clinical data were obtained from the GEMSTONE-303 trial, drug costs were determined based on national bidding prices, and other costs and utility values were obtained from published literature. Outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was used to verify the robustness of the model.The SUG-CAP incurred costs of $70,673.28 and gained 1.28 QALYs. In the PLA-CAP, the effectiveness was 1.00 QALYs at a cost of $11,241.52. Compared with PLA-CAP, SUG-CAP yielded an increase of 0.28 QALYs at an incremental cost of $59,431.76. The ICER for SUG-CAP versus PLA-CAP was $217,686.71 per QALY, which exceeds the preset willingness-to-pay threshold of $41,511 per QALY, with a 0% probability of being cost-effective. The parameters that significantly affected the model were the cost of sugemalimab, progression-free survival utility, and discount rate.From the perspective of China's healthcare system, SUG-CAP as first-line therapy for advanced G/GEJ adenocarcinoma with PD-L1 CPS ≥5 is not cost-effective compared with chemotherapy alone.
Keywords: sugemalimab, Cost-Effectiveness, First-line treatment, gastric or gastroesophageal junction adenocarcinoma, PD-L1
Received: 04 Apr 2025; Accepted: 24 Jul 2025.
Copyright: © 2025 He, Zhang and You. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maojin You, Mindong Hospital, Fujian Medical University, Ningde, China
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