{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:29:07Z","timestamp":1787027347853,"version":"build-2736575974"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Results from the GEMSTONE-303 trial indicate that compared with placebo plus capecitabine and oxaliplatin (PLA-CAP), sugemalimab plus capecitabine and oxaliplatin (SUG-CAP) as first-line therapy provides clinical benefits for patients with advanced gastric or gastroesophageal junction (G\/GEJ) adenocarcinoma with programmed cell death ligand 1 (PD-L1) combined positive score (CPS) \u22655. However, the addition of sugemalimab increases medical costs. This study aimed to assess the cost-effectiveness of SUG-CAP vs. PLA-CAP for the first-line treatment of advanced G\/GEJ adenocarcinoma with PD-L1 CPS \u22655 from the perspective of China's healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Markov model with three health states was developed to compare the cost-effectiveness of SUG-CAP and PLA-CAP. Clinical data were obtained from the GEMSTONE-303 trial, drug costs were determined based on national bidding prices, and other costs and utility values were obtained from published literature. Outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analysis was used to verify the robustness of the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The SUG-CAP incurred costs of $70,673.28 and gained 1.28 QALYs. In the PLA-CAP, the effectiveness was 1.00 QALYs at a cost of $11,241.52. Compared with PLA-CAP, SUG-CAP yielded an increase of 0.28 QALYs at an incremental cost of $59,431.76. The ICER for SUG-CAP vs. PLA-CAP was $217,686.71 per QALY, which exceeds the preset willingness-to-pay (WTP) threshold of $41,511 per QALY, with a 0% probability of being cost-effective. The parameters that significantly affected the model were the cost of sugemalimab, progression-free survival (PFS) utility, and discount rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>From the perspective of China's healthcare system, SUG-CAP as first-line therapy for advanced G\/GEJ adenocarcinoma with PD-L1 CPS \u22655 is not cost-effective compared with chemotherapy alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1604372","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T05:27:56Z","timestamp":1755840476000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Cost-effective analysis of sugemalimab plus chemotherapy as first-line treatment for advanced gastric or gastroesophageal junction adenocarcinoma with PD-L1 CPS 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