Cost-effectiveness of trifluridine/tipiracil against nivolumab for heavily pretreated metastatic gastric cancer in Japan

Yusuke Takushima; Ataru Igarashi; Hiroshi Yoshihara; Kohei Shitara; Toshihiko Doi

doi:10.1093/jjco/hyab086

Cost-effectiveness of trifluridine/tipiracil against nivolumab for heavily pretreated metastatic gastric cancer in Japan

Jpn J Clin Oncol. 2021 Aug 30;51(9):1383-1390. doi: 10.1093/jjco/hyab086.

Authors

Yusuke Takushima^{1

2}, Ataru Igarashi^{1

3}, Hiroshi Yoshihara¹, Kohei Shitara⁴, Toshihiko Doi⁵

Affiliations

¹ Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
² Medical Affairs Department, Taiho Pharmaceutical Co., Ltd, 1-27 Kandanishiki-cho, Chiyoda-ku, Tokyo 101-8444, Japan.
³ Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa Japan.
⁴ Department of Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
⁵ Department of Experimental Therapeutics, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.

Abstract

Objective: Nivolumab and trifluridine/tipiracil have significantly improved the overall survival of patients with heavily pretreated metastatic gastric cancer in different placebo-controlled phase III trials. Accordingly, nivolumab and trifluridine/tipiracil have been approved and recommended for patients with heavily pretreated metastatic gastric cancer in Japan. The aim of this study was to assess the cost-effectiveness of trifluridine/tipiracil against nivolumab.

Methods: A partitioned survival model, which consisted of three health states, namely, 'pre-progression,' 'post-progression,' and 'death,' was constructed. Efficacy and safety data were derived from the TAGS and ATTRACTION-2 trials. Costs were estimated based on the standard clinical pathway and national insurance fee schedules. One-way and probabilistic sensitivity analyses were performed. The threshold value was set to JPY 7 500 000 (USD 68 182) for each quality-adjusted life-year.

Results: The expected median overall survival and progression-free survival were 5.59 and 1.99 months for trifluridine/tipiracil and 5.26 and 1.55 months for nivolumab, respectively. The quality-adjusted life-year and expected costs per patient were 0.4379 and JPY 2 054 625 (USD 18 678) for trifluridine/tipiracil and 0.5295 and JPY 5 018 148 (USD 45 620) for nivolumab, respectively. The expected median progression-free survival and overall survival were equivalent with trifluridine/tipiracil and nivolumab, whereas the expected quality-adjusted life-year with trifluridine/tipiracil was slightly lower than that with nivolumab. However, trifluridine/tipiracil reduced the total treatment cost by JPY 2 963 523 (USD 26 996) compared with that of nivolumab. The incremental cost-effectiveness ratio of nivolumab versus trifluridine/tipiracil was JPY 32 352 489 (USD 294 113) per quality-adjusted life-year gained.

Conclusions: Trifluridine/tipiracil was more cost-effective than nivolumab for patients with heavily pretreated metastatic gastric cancer.

Keywords: TAS-102; cost-effectiveness analysis; nivolumab; stomach neoplasm; trifluridine/tipiracil.

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Colorectal Neoplasms* / drug therapy
Cost-Benefit Analysis
Drug Combinations
Humans
Japan
Nivolumab / therapeutic use
Pyrrolidines
Stomach Neoplasms* / drug therapy
Thymine
Trifluridine / therapeutic use
Uracil / therapeutic use

Substances

Drug Combinations
Pyrrolidines
Nivolumab
Uracil
tipiracil
Thymine
Trifluridine

Grants and funding

Taiho Pharmaceutical