Cost-Utility Analysis of the Oral Fluoropyrimidine S-1 Versus Conventional Intravenous Chemotherapy in Advanced or Recurrent Gastric Cancer

Objective: The aim of this study was to compare the cost-utility of S-1, an oral anticancer agent developed in Japan, and conventional intravenous chemotherapy in patients with advanced or recurrent gastric cancer on the basis of the cost and quality of life (QOL) data we previously reported. Methods: Patients with advanced or recurrent gastric cancer who could ingest food were identified retrospectively from the ordering system database of Showa University Hospital between January 1998 and July 2001. Costs incurred during chemotherapy were calculated on the basis of hospital billing data. The utilities of chemotherapy were assessed by oncology pharmacists and nurses on the basis of the patients’ medical records. Cost-utility analysis was conducted from a societal perspective. Results: Of the 23 patients who met the inclusion criteria, 13 received S-1 (S-1 group) and 10 received conventional intravenous chemotherapy (IV chemotherapy group). The average (± SE) monthly cost during chemotherapy was significantly lower in the S-1 group (327,640 ± 47,647 yen) than in the IV chemotherapy group (852,874 ± 62,412 yen). Average (± SE) utilities in the S-1 group (0.84 ± 0.02 0.94 ± 0.01) were significantly higher than those in IV chemotherapy group (0.52 ± 0.04 0.79 ± 0.02). Conclusion: S-1 is a dominant strategy with lower costs and better health outcomes than conventional intravenous chemotherapy in patients with advanced or recurrent gastric cancer.