The most used treatments for gastric cancer include complete resection with adequate margins, with either perioperative chemotherapy or adjuvant chemoradiotherapy. However, of these two treatment options, the optimal treatment is unknown.

Aiming to identify the optimal treatment for this patient population, Vishnu Prasath, MS, Rutgers-New Jersey Medical School, Newark, NJ, and colleagues built a decision tree model, analyzing the survival and costs associated with perioperative chemotherapy compared with adjuvant chemoradiotherapy.

Medicare reimbursement rates from a third-party payer perspective were used to estimate costs for the decision tree model, and effectiveness was measured using quality-adjusted life years (QALYs).

One-way, two-way, and probabilistic sensitivity analyses were conducted to test the conclusions of this study.

The cost of perioperative chemotherapy for the treating diagnosed gastric cancer was $54,326.10, while the cost of adjuvant chemoradiotherapy was $77,987.52. Patients receiving perioperative chemotherapy had 4.08 QALYs, and patients receiving CRT had 4.28 QALYs.

Perioperative chemotherapy was the preferred treatment modality for this study, as it did not surpass $100,000 per QALYs gained. However, adjuvant chemoradiotherapy was favored when adjuvant chemoradiotherapy non-curative procedure rates rose 3% higher than perioperative chemotherapy non-curative procedure rates and when perioperative chemotherapy complication rates rose 15% higher than CRT complication rates.

“In our simulated patients with diagnosed gastric cancer, the most cost-effective treatment strategy was perioperative chemotherapy,” wrote Dr Prasath and colleagues, concluding, “We see cost-effectiveness alternating to favor adjuvant chemoradiotherapy with changes in non-curative procedure rates and adjuvant therapy complication rates.”—Marta Rybczynski