OBJECTIVES: The Brazilian Private Health Care Sector has first-line and second-line metastatic gastric cancer (mGC) treatment options using traditional chemotherapy and targeted therapy. Recently, trifluridine and tipiracil hydrochloride (FTD/TPI) was approved in the third-line treatment and is the only treatment option to this subgroup of patients. Our objective was to evaluate the cost-effectiveness of FTD/TPI in mGC patients, including gastroesophageal junction adenocarcinoma, who have received at least two prior therapies for metastatic disease and are eligible for third-line treatment, from the perspective of private health care sector in Brazil.

METHODS: A partitioned survival model was constructed for this analysis over a 5-year time horizon. Best supportive care (BSC) was set as comparator. Efficacy, safety data and utility values were extracted from published studies. Resource consumption data were obtained from local experts and was combined with unit costs obtained from official sources. Primary outcomes were patients’ life years (LYs), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) per QALY and LYs gained. Both cost and outcomes were discounted at 5% per year. A probabilistic and deterministic sensitivity analysis were conducted.

RESULTS: In terms of health outcomes, FTD/TPI was associated with 0.173 increment in LYs compared with BSC. Furthermore, FTD/TPI was associated with 0.114 increment in QALYs compared with BSC, resulting in ICERs of BRL 271,892.32 per LY gained and BRL 413,509.32 per QALY gained versus BSC.

CONCLUSIONS: The cost-effectiveness analysis compared to the BSC reflects the introduction of a therapeutic option for third-line treatment for patients with mGC, filling a treatment gap in Private Health Care Sector in Brazil. The result is relevant, considering that this population must deal with the rapid and aggressive progression of the disease. Besides, there is no tangible new technology identified on the horizon that could represent a better benefit to be made available to the patient.