ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1500729
Cost-effectiveness analysis of tislelizumab plus chemotherapy as first-line treatment for HER2-negative advanced gastric or gastro-oesophageal junction adenocarcinoma
Provisionally accepted
Liangliang Zou
Cuihua Yuan*- Mindong Hospital, Fujian Medical University, Ningde, China
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The RATIONALE-305 trial indicates that tislelizumab plus chemotherapy (TLE-CHM) offers clinical benefits over placebo plus chemotherapy (PLB-CHM) as a first-line treatment for patients with HER2-negative advanced gastric or gastro-oesophageal junction (G/GEJ) adenocarcinoma. Nonetheless, incorporating tislelizumab results in higher treatment costs, raising concerns about its costeffectiveness relative to PLB-CHM. This study aimed to assess the cost-effectiveness of TLE-CHM as an initial treatment for HER2-negative advanced G/GEJ adenocarcinoma from the perspective of the Chinese healthcare system.: A Markov partitioned survival model incorporating three health states was developed to evaluate the cost-effectiveness of TLE-CHM as a first-line treatment for advanced G/GEJ adenocarcinoma. Clinical data were sourced from the RATIONALE-305 trial, with drug costs calculated at the national tender price, and additional costs and utility values derived from published literature. The outcomes measured included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to validate the model's robustness. Results: TLE-CHM achieved 1.53 QALYs at a cost of $23,484.39, compared to 1.14 QALYs at $12,123.52 for PLB-CHM. The ICER for TLE-CHM versus PLB-CHM was $29,608.51 per QALY gained. Key parameters influencing the model results included PFS utility, the cost of tislelizumab, and disease progression utility. At a willingnessto-pay threshold of $19,067 per QALY, TLE-CHM had an 0.8% probability of being cost-effective compared to PLB-CHM.From the perspective of the Chinese healthcare system, TLE-CHM is not a cost-effective first-line treatment for advanced G/GEJ adenocarcinoma compared to chemotherapy.
Keywords: tislelizumab, chemotherapy, Cost-Effectiveness, First-line treatment, HER2-negative, gastric or gastroesophageal adenocarcinoma
Received: 23 Sep 2024; Accepted: 08 Apr 2025.
Copyright: © 2025 Zou and Yuan. 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: Cuihua Yuan, Mindong Hospital, Fujian Medical University, Ningde, China
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