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Cost-Effectiveness of Trifluridine/Tipiracil (FTD/TPI) As a Third-LINE Treatment of Metastatic Gastric Cancer, Including Adenocarcinoma of the Gastroesophageal Junction, Among Patients WHO Have Received at Least Two PRIOR Therapies for Metastatic Disease

14 July 2021
Gourzoulidis G, Koulentaki M, Koumarianou A, Samantas E, Androulakis N, Xynogalos S, et al Value in Health. 2020;23:S439.

Objectives: To evaluate the cost-effectiveness of trifluridine/tipiracil (FTD/TPI) compared with best supportive care (BSC) for the treatment of patients with metastatic gastric cancer (mGC), including gastroesophageal junction adenocarcinoma (GEJ), who have received at least two prior therapies for metastatic disease and are eligible for third-line treatment, in Greece.

Methods: A partitioned survival model was locally adapted from a public payer perspective over a 10-year time horizon. Efficacy, safety data, and utility values were extracted from relevant clinical trials and the literature. Resource consumption data obtained from a panel of local experts using a questionnaire developed for the study was combined with unit costs obtained from official sources. All costs reflect the year 2020 (€). Primary outcomes of the model were patients’ life years (LYs) and quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) per QALYs and LYs gained. Both cost and outcomes were discounted at 3.5% per year. Sensitivity analyses were used to explore the impact in changing input data.

Results: The total cost per patient was estimated to be €6,965 for FTD/TPI and €1,906 for BSC. In terms of health outcomes, FTD/TPI was associated with 0.180 and 0.107 increments in LYs and QALYs, respectively, compared with BSC, resulting in an ICER of €47,144 per QALY gained and €28,112 per LY gained. One-way sensitivity analysis reported that the most influential parameters on the model results was the FTD/TPI time on treatment data. At the defined willingness-to-pay threshold of €54,000 per QALY gained, probabilistic sensitivity analysis showed that FTD/TPI was estimated to have a 64% probability of being cost-effective compared with BSC.

Conclusions: The results indicated that FTD/TPI was estimated to be a cost-effective treatment option for eligible third-line mGC patients, including GEJ, who have received at least two prior therapies for metastatic disease in Greece.