First-line treatments for Advanced Gastric Cancer with Sugemalimab Plus Chemotherapy ： a China-based cost-effectiveness analysis

Objective This study aimed to evaluate the cost-effectiveness of sugemalimab plus chemotherapy as first-line treatment for advanced gastric cancer patients with PD-L1 combined positive score (CPS) ≥ 5 from the perspective of the Chinese healthcare system. Methods A Markov model was developed to simulate patient transitions among progression-free survival, progressive disease, and death. Both one-way and probabilistic sensitivity analyses were conducted. A scenario analysis was also performed for patients with CPS ≥ 10. Results In the base-case analysis, sugemalimab plus chemotherapy yielded 1.345 QALYs at a cost of $206,603.7, whereas chemotherapy alone achieved 0.841 QALYs at $174,815.2, resulting in an incremental cost-effectiveness ratio (ICER) of $63,071.33 per QALY. In the CPS ≥ 10 subgroup, the ICER was $95,962.19 per QALY, still exceeding the WTP threshold. Sensitivity analyses indicated that the cost of sugemalimab was the primary driver of ICER variability. Probabilistic sensitivity analysis confirmed a low probability of cost-effectiveness at current drug prices. Conclusions Although sugemalimab combined with chemotherapy demonstrates substantial clinical benefits for advanced gastric cancer patients, particularly those with high PD-L1 expression, its current cost substantially limits its economic feasibility in China.