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Background <p>Although laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) show comparable short- and long-term efficacy for treating locally advanced gastric cancer (LAGC), evidence on the cost-effectiveness of LDG versus ODG remains limited. This study aimed to evaluate the long-term cost-effectiveness of LDG versus ODG in patients with LAGC at different stages from a societal perspective in China.</p> Methods <p>A Markov model incorporating three health states (stable disease, disease progression, and death) was constructed based on data from the CLASS-01 trial. The outcome measures included incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs). Cost-effectiveness was assessed by comparing the ICER to the willingness-to-pay (WTP) threshold. Sensitivity analyses were conducted to evaluate model uncertainty.</p> Results <p>In stage I patients, the model projected that LDG provided 0.29 incremental QALYs at an incremental cost of $819.33, yielding an ICER of $2829.98/QALY—below the WTP threshold, indicating potential cost-effectiveness conditional on the model parameters. Conversely, in stage II and III patients, ODG was associated with higher QALY gains than LDG (simulated incremental QALYs of −&#xa0;0.14 and −&#xa0;0.22, respectively), and the ICERs were negative (stage II: ICER −&#xa0;$7692.45 per QALY, incremental cost $1073.62; stage III: ICER −&#xa0;$4232 per QALY, incremental cost $913.41), suggesting that ODG was the cost-effective strategy within the simulation framework. Sensitivity analyses indicated that base-case findings were robust to parameter uncertainty.</p> Conclusion <p>Based on the model’s assumptions and parameterization, the simulated results indicate that LDG is likely cost-effective in stage I patients, while ODG appears more advantageous in stage II and III patients.</p>

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Cost-effectiveness analysis of laparoscopic versus open distal gastrectomy for locally advanced gastric cancer based on TNM stage: a Markov model

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Min Lai,
  • Qingqing Qin,
  • Yanting Li,
  • Wenzhen Yuan

摘要

Background

Although laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) show comparable short- and long-term efficacy for treating locally advanced gastric cancer (LAGC), evidence on the cost-effectiveness of LDG versus ODG remains limited. This study aimed to evaluate the long-term cost-effectiveness of LDG versus ODG in patients with LAGC at different stages from a societal perspective in China.

Methods

A Markov model incorporating three health states (stable disease, disease progression, and death) was constructed based on data from the CLASS-01 trial. The outcome measures included incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs). Cost-effectiveness was assessed by comparing the ICER to the willingness-to-pay (WTP) threshold. Sensitivity analyses were conducted to evaluate model uncertainty.

Results

In stage I patients, the model projected that LDG provided 0.29 incremental QALYs at an incremental cost of $819.33, yielding an ICER of $2829.98/QALY—below the WTP threshold, indicating potential cost-effectiveness conditional on the model parameters. Conversely, in stage II and III patients, ODG was associated with higher QALY gains than LDG (simulated incremental QALYs of − 0.14 and − 0.22, respectively), and the ICERs were negative (stage II: ICER − $7692.45 per QALY, incremental cost $1073.62; stage III: ICER − $4232 per QALY, incremental cost $913.41), suggesting that ODG was the cost-effective strategy within the simulation framework. Sensitivity analyses indicated that base-case findings were robust to parameter uncertainty.

Conclusion

Based on the model’s assumptions and parameterization, the simulated results indicate that LDG is likely cost-effective in stage I patients, while ODG appears more advantageous in stage II and III patients.