Cost-effectiveness analysis of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with gastric cancer and peritoneal metastasis. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Javanbakht, Mehdi; Mashayekhi, Atefeh; Branagan-Harris, Michael; Horvath, Philipp; Königsrainer, Alfred; Reymond, Marc A.; Yaghoubi, Mohsen
• Is Part Of: European journal of surgical oncology. Volume 48:Issue 1(2022)
• Page Start: 188
• Page End: 196
• Publication Date: 2022-01
• Subjects: Cost-effectiveness -- Pressurized intraperitoneal aerosol chemotherapy -- Gastric cancer; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.08.024
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Objective: The aim of this study was to assess the cost-effectiveness of pressurized intraperitoneal aerosol chemotherapy with low-dose cisplatin and doxorubicin (PIPAC C/D) for the treatment of advanced gastric cancer. Methods: A Partitioned Survival Model followed by state transition Markov model was developed to estimate the costs and effectiveness of the use of PIPAC C/D versus palliative chemotherapy in the UK. The intervention was assessed at two different levels of care, including upfront therapy (PIPAC C/D plus Oxaliplatin in combination with Capecitabine (XELOX) chemotherapy versus first-line chemotherapy alone) and second-line therapy (PIPAC C/D alone versus second-line chemotherapy (ramucirumab monotherapy)). Data from multiple sources, including published literature and UK-based databases, were used to inform the economic model. Results: For the upfront therapy analysis, the estimated total costs in the intervention and comparator arms were £32, 606 (SD: £3877) and £17, 844 (SD: £920), respectively. PIPAC C/D plus XELOX led to an increase of 0.46 in quality-adjusted life-years (QALYs) gained. The incremental cost per QALY gained was £31, 868. For the second-line therapy analysis, the use of PIPAC C/D led to an increase of 0.19 in QALYs and a £21, 474 reduction in costs, meaning the intervention was a dominant strategy. Conclusions: The cost-effectiveness results for the upfront therapy analysis indicate that PIPAC C/D plus chemotherapy is a cost-effective strategy. Additionally, PIPAC C/D alone as a second-line therapy has the potential to reduce costs and improve clinical outcomes for patients with advanced gastric cancer with peritoneal metastasis.