{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:33:48Z","timestamp":1789475628091,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"22","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the cost\u2010effectiveness of pembrolizumab in combination with trastuzumab and chemotherapy (PEM\u2009+\u2009TRAS\u2009+\u2009Chemo) as a first\u2010line treatment for patients with advanced HER2\u2010positive gastric or gastroesophageal junction (GEJ) adenocarcinoma from the perspective of the Chinese healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data from the KEYNOTE\u2010811 trial were used to develop a partitioned survival model for HER2\u2010positive gastric or GEJ adenocarcinoma. The model estimated quality\u2010adjusted life years (QALYs), life years (LYs), and total lifetime costs. The primary outcome was the Incremental Cost\u2010Effectiveness Ratio (ICER), reflecting the cost per additional QALY. Only direct medical costs were considered, with drug prices sourced from the China Drug Bidding Database and other costs and utility values derived from published literature. Uncertainty analyses were conducted to test the robustness of the model, and subgroup analyses were performed to assess cost\u2010effectiveness in different patient populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the base\u2010case analysis, the PEM\u2009+\u2009TRAS\u2009+\u2009Chemo regimen increased LYs by 0.17 and QALYs by 0.19, at an additional cost of $9874.08, resulting in an ICER of $53,160.95\/QALY, which exceeds three times the per capita GDP of China ($39,999.86). Subgroup analysis based on the patient's programmed death\u2010ligand 1 (PD\u2010L1) combined positive score (CPS) showed that for PD\u2010L1 (CPS \u2265\u20091) patients, the ICER was $49,849.43 per QALY. Uncertainty analysis indicated that the proportion of patients receiving subsequent systemic treatment had the most significant impact on the model results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In China, for first\u2010line treatment of HER2\u2010positive advanced gastric or GEJ adenocarcinoma, the PEM\u2009+\u2009TRAS\u2009+\u2009Chemo regimen is not cost\u2010effective when compared to the TRAS\u2009+\u2009Chemo regimen, unless the price of pembrolizumab is reduced.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71379","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:13:36Z","timestamp":1763644416000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost\u2010Effectiveness of Pembrolizumab Plus Trastuzumab and Chemotherapy Versus Trastuzumab Plus Chemotherapy as First\u2010Line Treatment of HER2\u2010Positive Gastric or Gastroesophageal Junction Adenocarcinoma in China"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2634-2910","authenticated-orcid":false,"given":"Yifang","family":"Liang","sequence":"first","affiliation":[{"name":"School of International Pharmaceutical Business China Pharmaceutical University  Nanjing Jiangsu Province China"},{"name":"Center for Pharmacoeconomics and Outcomes Research China Pharmaceutical University  Nanjing Jiangsu Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyanzi","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of International Pharmaceutical Business China Pharmaceutical University  Nanjing Jiangsu Province China"},{"name":"Center for Pharmacoeconomics and Outcomes Research China Pharmaceutical University  Nanjing Jiangsu Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongfei","family":"Hu","sequence":"additional","affiliation":[{"name":"School of International Pharmaceutical Business China Pharmaceutical University  Nanjing Jiangsu Province China"},{"name":"Center for Pharmacoeconomics and Outcomes Research China Pharmaceutical University  Nanjing Jiangsu Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9538-5609","authenticated-orcid":false,"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"School of International Pharmaceutical Business China Pharmaceutical University  Nanjing Jiangsu Province China"},{"name":"Center for Pharmacoeconomics and Outcomes Research China Pharmaceutical University  Nanjing Jiangsu Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aixia","family":"Ma","sequence":"additional","affiliation":[{"name":"School of International Pharmaceutical Business China Pharmaceutical University  Nanjing Jiangsu Province China"},{"name":"Center for Pharmacoeconomics and Outcomes Research China Pharmaceutical University  Nanjing Jiangsu Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Guan","sequence":"additional","affiliation":[{"name":"School of International Pharmaceutical Business China Pharmaceutical University  Nanjing Jiangsu Province China"},{"name":"Center for Pharmacoeconomics and Outcomes Research China Pharmaceutical University  Nanjing Jiangsu Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jncc.2024.01.006"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112338\u201020231120\u201000295"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.7150\/jca.95311"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16091747"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.5230\/jgc.2023.23.e6"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cnr2.2076"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(23)00215\u20102"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41416\u2010023\u201002559\u20106"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14041054"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.3370"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)01234\u20104"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(23)02033\u20100"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2408121"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575\u2010022\u201000703\u2010w"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms241411403"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000002614"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/cac2.12516"},{"key":"e_1_2_10_20_1","volume-title":"China Guidelines for Pharmacoeconomic Evaluations","author":"Liu G.","year":"2020"},{"key":"e_1_2_10_21_1","volume-title":"US Dollar (USD) to Chinese Yuan Renminbi (CNY) 2024 Historical Exchange Rates","author":"VALUTA FX","year":"2024"},{"key":"e_1_2_10_22_1","volume-title":"Guangxi Medical Service Project Prices (2021 Edition)","author":"Guangxi Zhuang Autonomous Region Medical Insurance Bureau","year":"2021"},{"key":"e_1_2_10_23_1","volume-title":"Cancer Immunotherapy Patient Assistance Program. 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