{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:03:03Z","timestamp":1789448583909,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The final analysis of KEYNOTE-811 demonstrated that pembrolizumab plus trastuzumab and chemotherapy significantly improved both overall survival (OS) and progression-free survival (PFS) compared to trastuzumab plus chemotherapy alone. Based on these latest findings, this study evaluated the cost-effectiveness of pembrolizumab plus trastuzumab and chemotherapy from the perspective of the Chinese healthcare system.\u200b<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Using a partitioned survival model, this study compared quality-adjusted life years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs) between pembrolizumab plus trastuzumab and chemotherapy versus trastuzumab plus chemotherapy alone. Efficacy and safety data were derived from KEYNOTE-811, local databases, and relevant literature. To validate the robustness of the model results, sensitivity analyses were conducted. Additionally, subgroup analyses were conducted specifically for the patient population with PD-L1 expression \u22651%.\u200b<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Pembrolizumab plus trastuzumab and chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Total costs, life years, quality adjusted life years (QALYs), incremental QALYs and incremental cost-effectiveness ratio (ICER).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the intention-to-treat (ITT) population, pembrolizumab plus trastuzumab and chemotherapy demonstrated a gain of 0.56 QALYs compared to trastuzumab plus chemotherapy alone, with an additional cost of $322,653.47, resulting in an ICER of $571,997.42\/QALY. In the PD-L1\u2009\u2265\u20091 subgroup, the pembrolizumab combination arm showed a QALY improvement of 0.38, yielding an ICER of $1,178,714.74 per QALY.\u200b<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>From the perspective of Chinese healthcare system, the addition of pembrolizumab to trastuzumab-chemotherapy as first-line therapy failed to demonstrate cost-effectiveness for HER2-positive gastric\/gastroesophageal junction adenocarcinoma across both the ITT population and PD-L1\u2009\u2265\u20091 subgroup.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1905243","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:27:23Z","timestamp":1789446443000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness analysis of pembrolizumab plus trastuzumab and chemotherapy as first-line treatment for HER2-positive gastric or gastroesophageal junction adenocarcinoma"],"prefix":"10.3389","volume":"13","author":[{"given":"Haoyu","family":"Yang","sequence":"first","affiliation":[{"name":"School of Health Economics and Management, Nanjing University of Chinese Medicine","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihao","family":"Ge","sequence":"additional","affiliation":[{"name":"School of Health Economics and Management, Nanjing University of Chinese Medicine","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuxian","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Health Economics and Management, Nanjing University of Chinese Medicine","place":["Nanjing, Jiangsu, 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