Cost-effectiveness analysis of laparoscopic versus open distal gastrectomy for locally advanced gastric cancer based on TNM stage: a Markov model

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Abstract
Background Although laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) show comparable short- and long-term efficacy for treating locally advanced gastric cancer (LAGC), evidence on the cost-effectiveness of LDG versus ODG remains limited. This study aimed to evaluate the long-term cost-effectiveness of LDG versus ODG in patients with LAGC at different stages from a societal perspective in China. Methods A Markov model incorporating three health states (stable disease, disease progression, and death) was constructed based on data from the CLASS-01 trial. The outcome measures included incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs). Cost-effectiveness was assessed by comparing the ICER to the willingness-to-pay (WTP) threshold. Sensitivity analyses were conducted to evaluate model uncertainty. Results In stage I patients, the model projected that LDG provided 0.29 incremental QALYs at an incremental cost of $819.33, yielding an ICER of $2829.98/QALY—below the WTP threshold, indicating potential cost-effectiveness conditional on the model parameters. Conversely, in stage II and III patients, ODG was associated with higher QALY gains than LDG (simulated incremental QALYs of − 0.14 and − 0.22, respectively), and the ICERs were negative (stage II: ICER − $7692.45 per QALY, incremental cost $1073.62; stage III: ICER − $4232 per QALY, incremental cost $913.41), suggesting that ODG was the cost-effective strategy within the simulation framework. Sensitivity analyses indicated that base-case findings were robust to parameter uncertainty. Conclusion Based on the model’s assumptions and parameterization, the simulated results indicate that LDG is likely cost-effective in stage I patients, while ODG appears more advantageous in stage II and III patients.

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