Costs of trastuzumab in combination with chemotherapy for HER2-positive advanced gastric or gastroesophageal junction cancer: does one “Analysis” fit all?

New cancer treatments are posing a significant financial burden on health-care systems worldwide. Cost effectiveness analyses of novel cancer treatments have received increased attention in oncology and are being used to make reimbursement decisions. In this article, we review a recently published economic evaluation of adding Trastuzumab to chemotherapy for HER2-Positive Advanced Gastric or Gastroesophageal Junction Cancer in China. The study suggests that the addition of trastuzumab to conventional chemotherapy might not be cost-effective based on incremental costeffectiveness ratios of $251,667.10/QALY gained. Although highlighting an opportunity for efficient investment in cancer care, we believe that the results of this analysis are not generalizable to other health care system. While the incremental cost-effectiveness is likely to remain quite large in any context, it is known that cost-effectiveness is heavily dependent on a ceiling ratio and a decision maker’s willingness to pay for a unit of quality of life gained.