Pharmacoeconomic Evaluation Of Brucea Javanica Injection Combined With First-line Chemotherapy For Postoperative Treatment Of Colorectal Cancer

Objectives In order to provide evidence-based medical evidence for the selection of clinical medical regimens and medical insurance decisions,meta-analysis was conducted on the postoperative treatment of colorectal cancer by Brucea javanica injection combined with first-line chemotherapy plan,and pharmacoeconomic evaluation was conducted based on the clinical medical costs of a third-class a hospital.Methods First of all,CNKI,Wanfang Data Online Knowledge Service Platform,VIP,MEDLINE,and PUBMED were searched by computer,to collect the published literature about the treatment of colorectal cancer with brucea javanica injection combined with FOLFOX regimen,Capeox regimen or FOLIRI regimen.Data from literature were extracted and meta-analysis was conducted by Rev Man5.4 software to evaluate the efficacy and safety of brucea javanica injection assisted first-line chemotherapy.Secondly,the decision tree model of Brucea javanica Injection combined with FOLFOX regimen,Cape OX regimen and FOLIRI regimen was constructed by using the objective remission rate weighted by all literature data in Meta analysis combined with the clinical medical cost of a third class A hospital.The optimal scheme was selected after the assignment,and the cost-effectiveness analysis of short-term efficacy was conducted.The results are expressed by cost-effectiveness ratio(C/E)and incremental coft-effectiveness ratio(ICER).Finally,three regimes of sensitivity analysis are used to test the stability of economic evaluation results.Results According to the inclusion and exclusion criteria,all the detected literatures were screened,and 26 standard compliant literatures were obtained,including 15 literatures of combined FOLFOX regimen,6 literatures of Cape OX regimen and 5 literatures of FOLIRI regimen.The results of meta-analysis showed that the overall objective remission rate[RR=1.31,95%CI:(1.21,1.41)] and the improvement rate of quality of life [RR=1.26,95%CI:(1.14,1.39)] in brucea javanica injection combined group were higher than those in the control group,P < 0.05,the difference was statistically significant.The overall incidence of adverse reactions in the combined group was nausea and vomiting [RR=0.71,95%CI:(0.57,0.88)];Leukopenia [RR=0.54,95%CI:(0.46,0.64)];Thrombocytopenia[RR=0.55,95%CI:(0.42,0.72)],the incidence of these adverse reactions in the combined group was lower than that in the control group,P < 0.05,the differences were statistically significant.After weighted treatment,objective response rate of FOLFOX combination group and control group were 63.54% and 46.33%,C/E were 45367.12 and 53592.70,and ICER was 23223.53.The decision tree model showed that the optimal regimen was the combination group.Objective response rate of Cape OX combination group and control group were 70.70% and 59.54%,C/E were 37649.04 and 40661.89,ICER was 34245.34,the decision tree model showed that the combination group was the optimal regimen.Objective response rate of FOLIRI combination group and control group were 75.19% and59.31%,C/E were 50483.64 and 56859.79,and ICER was 26669.46.The decision tree model showed that the optimal regimen was the combined group.Sensitivity analysis showed that the results of pharmacoeconomic evaluation were stable.Conclusions Brucea javanica injection combined with FOLFOX,Cape OX and FOLIRI(three first-line chemotherapy regimens)has better safety and effectiveness in postoperative treatment of colorectal cancer than chemotherapy alone,and has obvious pharmacoeconomic advantages.Figure 20;Table 15;Reference 99...