RESUMO
Background: Endostar and platinum were widely used in the treatment of malignant pleural effusion (MPE), but there was no unified conclusion on which scheme is the best. The aim of this study was to systematically evaluate the efficacy and cost-effectiveness of Endostar, cisplatin, lobaplatin, Endostar combined with cisplatin, and Endostar combined with lobaplatin in the treatment of MPE so as to provide a reference for clinical treatment. Methods: A comprehensive literature search was performed of sources on PubMed, Web of Science, and other databases published up to and including November 23, 2021, and screened out randomized controlled trial (RCT) concerning the efficacy of 5 interventions of pleural perfusion for MPE. The Cochrane Collaboration tool was used for assessing the risk of bias, and a network meta-analysis was performed with Addis software based on the Bayesian framework. A decision tree model was used to complete a cost-effectiveness analysis that was based on the direct medical costs and the probabilities were determined from the network meta-analysis. The one-way sensitivity analysis was presented with a tornado chart. In the probabilistic sensitivity analysis, the cost-effectiveness acceptability curve was obtained after Monte Carlo simulation. Results: A total of 55 studies were included, comprising 3,379 total patients, excluding the unclear part, we evaluated as low risk of bias. According to the network meta-analysis, Endostar combined with lobaplatin had the highest effectiveness, followed by Endostar combined with cisplatin, Endostar, cisplatin, and lobaplatin. In the incremental cost-effectiveness ratio (ICER) analysis, lobaplatin and Endostar were excluded as inferior schemes. With cisplatin as the comparison, the ICER of Endostar combined with cisplatin was yuan renminbi ¥22,648.31. With Endostar combined with cisplatin as the comparison, the ICER of Endostar combined with lobaplatin was ¥236,502.67. The results of sensitivity analysis and cost-effectiveness analysis were basically consistent. Conclusions: Endostar combined with lobaplatin had the highest effectiveness, but its ICER was relatively too high to be acceptable. Therefore, cisplatin alone and Endostar combined with cisplatin were more cost-effective, and clinicians can choose the optimal treatment scheme based on the willingness to pay (WTP) of different patients with comprehensive consideration of effectiveness and economy.
RESUMO
Background: Crizotinib and ensartinib improved survival in patients with ALK arrangement non-small-cell lung cancer (NSCLC); however, the economic outcomes of using ensartinib versus crizotinib are still unclear. Aim: The objective of this study was to assess the cost-effectiveness of ensartinib versus crizotinib for ALK-positive NSCLC patients from the perspective of China's healthcare system. Methods: A partitioned survival model with three health states (stable, progressive and death) was developed. Survival data were obtained from published eXalt3 clinical trials of ensartinib verses crizotinib for patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer. Parametric models were used to extrapolate outcomes beyond the trial period. The drug cost comes from the local drug procurement platform. Other costs and utility values were obtained from published literature, and one-way and probabilistic sensitivity analyses were carried out to determine the robustness of the model outcomes. Results: In the whole life cycle, the average annual cost of ensatinib was US$77,636.63, and utility value was 5.5 quality adjusted life years (QALYs). Patients receiving crizotinib had 3.315QALYs and US$32,935.88 costs over the same time horizon. The incremental cost utility ratio is US$19,810.55/QALYs. In 2021, the per capita GDP of China is US$12,721.33, and the incremental cost utility is lower than the threshold of willingness to pay US$38,163.99. Conclusion: Compared with crizotinib, ensatinib is economical in the treatment of ALK-positive NSCLC and should be promoted.