{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:24:01Z","timestamp":1789687441831,"version":"4.0.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018684","name":"National Health Commission of the People's Republic of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018684","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated the cost-effectiveness of perioperative durvalumab plus FLOT compared with FLOT alone in patients with resectable gastric and gastroesophageal junction (G\/GEJ) adenocarcinoma in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a semi-Markov model to evaluate the cost-effectiveness of perioperative durvalumab plus FLOT compared with FLOT alone from the perspective of U.S. healthcare payers. The model utilized a 10-year time horizon with a 4-week cycle length. Clinical efficacy and safety data were primarily derived from the phase III MATTERHORN trial, while transition probabilities for subsequent lines of therapy were extrapolated from the RAINBOW trial. Direct medical costs were estimated using 2025 pricing data from CMS fee schedules and published literature. Health utility values were obtained from previous studies. Both costs and outcomes were discounted at an annual rate of 3%. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with perioperative FLOT alone, the addition of durvalumab provided an additional 0.84 QALY, with an incremental cost of $104,256.12, yielding an ICER of $124,661.87 per QALY gained. Sensitivity analyses indicated that the cost of durvalumab and the utility associated with event-free survival (EFS) were the key drivers of model uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>From the perspective of U.S. healthcare payers, perioperative durvalumab plus FLOT is a cost-effective strategy compared with FLOT alone for patients with resectable G\/GEJ adenocarcinoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1712403","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T06:47:15Z","timestamp":1770706035000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-effectiveness of perioperative durvalumab plus FLOT for resectable gastric and gastroesophageal junction adenocarcinoma in the United States"],"prefix":"10.3389","volume":"17","author":[{"given":"Jiahao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caicong","family":"You","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fujian Medical University Union Hospital","place":["Fuzhou, China"]},{"name":"The School of Pharmacy, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fujian Medical University Union Hospital","place":["Fuzhou, China"]},{"name":"The School of Pharmacy, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liushi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fujian Medical University Union Hospital","place":["Fuzhou, China"]},{"name":"The School of Pharmacy, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maobai","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fujian Medical University Union Hospital","place":["Fuzhou, China"]},{"name":"The School of Pharmacy, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fujian Medical University Union Hospital","place":["Fuzhou, China"]},{"name":"The School of Pharmacy, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"B1","unstructured":"Stomach (Gastric) cancer key statistics"},{"key":"B2","unstructured":"Cancer stat facts"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32557-1","article-title":"Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2\/3 trial","volume":"393","author":"Al-Batran","year":"2019","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3322\/caac.21871","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA: A Cancer J Clin"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.00975","article-title":"Durvalumab with or without tremelimumab in combination with chemotherapy as first-line therapy for metastatic non\u2013small-cell lung cancer","volume":"41","author":"Johnson","year":"2023","journal-title":"J Clin Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2408154","article-title":"Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer","volume":"391","author":"Powles","year":"2024","journal-title":"New Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2503701","article-title":"Perioperative durvalumab in gastric and gastroesophageal junction cancer","volume":"393","author":"Janjigian","year":"2025","journal-title":"New Engl J Med"},{"key":"B8","volume-title":"Research C for D E and. FDA approves durvalumab for resectable gastric or gastroesophageal junction adenocarcinoma","year":"2025"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70420-6","article-title":"Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial","volume":"15","author":"Wilke","year":"2014","journal-title":"Lancet Oncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1056\/NEJM198710223171717","article-title":"Simplified calculation of body-surface area","volume":"317","author":"Mosteller","year":"1987","journal-title":"New Engl J Med"},{"key":"B11","first-page":"1","article-title":"Anthropometric reference data for children and adults: United States, 2015-2018","author":"Fryar","year":"2021","journal-title":"Vital Health Statistics. Ser 3 Analytical Epidemiological Stud"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses","volume":"316","author":"Sanders","year":"2016","journal-title":"JAMA"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X16670617","article-title":"Estimation of survival probabilities for use in cost-effectiveness analyses: A comparison of a multi-state modeling survival analysis approach with partitioned survival and markov decision-analytic modeling","volume":"37","author":"Williams","year":"2017","journal-title":"Med Decision Making"},{"key":"B14","unstructured":"Lynparza"},{"key":"B15","volume-title":"Search the physician fee schedule","year":""},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2078-6891.2015.046","article-title":"Systematic review on quality of life outcomes after gastrectomy for gastric carcinoma","volume":"6","author":"Shan","year":"2015","journal-title":"J Gastrointestinal Oncol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"87","DOI":"10.5230\/jgc.2015.15.2.87","article-title":"Treatment patterns, costs, and survival among medicare-enrolled elderly patients diagnosed with advanced stage gastric cancer: analysis of a linked population-based cancer registry and administrative claims database","volume":"15","author":"Karve","year":"2015","journal-title":"J Gastric Cancer"},{"key":"B18","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.critrevonc.2015.12.012","article-title":"A systematic literature review of the economic implications of chemotherapy-induced diarrhea and its impact on quality of life","volume":"99","author":"Tarricone","year":"2016","journal-title":"Crit Rev Oncology\/Hematology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.3802\/jgo.2025.36.e6","article-title":"Immunotherapy plus chemotherapy in patients with advanced endometrial cancer: a cost-effectiveness analysis","volume":"36","author":"Y Z","year":"2024","journal-title":"J gynecologic Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-04795-0","article-title":"Febrile neutropenia-related care and associated costs in elderly patients with breast cancer, lung cancer, or non-Hodgkin lymphoma","volume":"28","author":"Li","year":"2020","journal-title":"Supportive Care Cancer: Off J Multinational Assoc Supportive Care Cancer"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020006052","article-title":"Cost effectiveness of caplacizumab in acquired thrombotic thrombocytopenic purpura","volume":"137","author":"Goshua","year":"2021","journal-title":"Blood"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34502","article-title":"Comparative cost-effectiveness of neoadjuvant chemotherapy regimens for muscle-invasive bladder cancer: Results according to VESPER data","volume":"128","author":"Joyce","year":"2022","journal-title":"Cancer"},{"key":"B23","doi-asserted-by":"publisher","first-page":"zrab129","DOI":"10.1093\/bjsopen\/zrab129","article-title":"Economic cost\u2013utility analysis of stage-directed gastric cancer treatment","volume":"5","author":"Powell","year":"2022","journal-title":"BJS Open"},{"key":"B24","doi-asserted-by":"publisher","first-page":"75s","DOI":"10.1200\/JOP.2011.000469","article-title":"Health care costs for patients with cancer at the end of life","volume":"8","author":"Chastek","year":"2012","journal-title":"J Oncol Pract"},{"key":"B25","unstructured":"Tom\u2019s inflation calculator"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2011.390","article-title":"Cost-effectiveness analysis of trastuzumab to treat HER2-positive advanced gastric cancer based on the randomised ToGA trial","volume":"105","author":"Shiroiwa","year":"2011","journal-title":"Br J Cancer"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/ajco.12477","article-title":"Health state utilities in non-small cell lung cancer: An international study","volume":"13","author":"Nafees","year":"2017","journal-title":"Asia-Pacific J Clin Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00069-8","article-title":"Disability weights for the Global Burden of Disease 2013 study","volume":"3","author":"Salomon","year":"2015","journal-title":"Lancet Global Health"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X12458348","article-title":"Model parameter estimation and uncertainty analysis: A report of the ISPOR-SMDM modeling good research practices task force working group\u20136","volume":"32","author":"Briggs","year":"2012","journal-title":"Med Decision Making"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA: A Cancer J Clin"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.30835","article-title":"Global patterns and trends in stomach cancer incidence: age, period and birth cohort analysis","volume":"141","author":"Luo","year":"2017","journal-title":"Int J Cancer"},{"key":"B32","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA: A Cancer J Clin"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00297-7","article-title":"Perioperative or postoperative adjuvant oxaliplatin with S-1 versus adjuvant oxaliplatin with capecitabine in patients with locally advanced gastric or gastro-oesophageal junction adenocarcinoma undergoing D2 gastrectomy (RESOLVE): an open-label, superiority and non-inferiority, phase 3 randomised controlled trial","volume":"22","author":"Zhang","year":"2021","journal-title":"Lancet Oncol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.851522","article-title":"Cost-effectiveness of nivolumab plus chemotherapy vs. Chemotherapy as first-line treatment for advanced gastric cancer\/gastroesophageal junction cancer\/esophagel adenocarcinoma in China","volume":"12","author":"Shu","year":"2022","journal-title":"Front Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2023.2219448","article-title":"Cost-effectiveness analysis of nivolumab-chemotherapy as first-line therapy for locally advanced\/metastatic gastric cancer: a United States payer perspective","volume":"23","author":"Marupuru","year":"2023","journal-title":"Expert Rev Pharmacoeconomics Outcomes Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e2413938","DOI":"10.1001\/jamanetworkopen.2024.13938","article-title":"International cost-effectiveness analysis of durvalumab in stage III non\u2013small cell lung cancer","volume":"7","author":"Kareff","year":"2024","journal-title":"JAMA Network Open"},{"key":"B37","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1186\/s12885-024-12043-w","article-title":"Cost-effectiveness of immunotherapies for advanced squamous non-small cell lung cancer: a systematic review","volume":"24","author":"Cheng","year":"2024","journal-title":"BMC Cancer"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31815c31a7","article-title":"What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule","volume":"46","author":"Braithwaite","year":"2008","journal-title":"Med Care"},{"key":"B39","doi-asserted-by":"publisher","first-page":"25","DOI":"10.7326\/M20-1392","article-title":"A health opportunity cost threshold for cost-effectiveness analysis in the United States","volume":"174","author":"Vanness","year":"2021","journal-title":"Ann Internal Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S151946","article-title":"Estimation of population-based utility weights for gastric cancer-related health states","volume":"12","author":"Lee","year":"2018","journal-title":"Patient Preference Adherence"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1712403\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T09:51:06Z","timestamp":1770717066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1712403\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":40,"alternative-id":["10.3389\/fimmu.2026.1712403"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1712403","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"article-number":"1712403"}}