Safety,Efficacy And Economic Evaluation Of Gefitinib Combined With Aidi Injection In The Treatment Of Non-small Cell Lung Cancer

Research purposes:The systematic evaluation of the safety and effectiveness of the molecular targeted drug gefitinib combined with Aidi injection compared with gefitinib alone in the treatment of non-small cell lung cancer.Introduce the Markov decision tree model and use the principles of pharmacoeconomic decision analysis to evaluate the long-term economics of two groups of treatments for non-small cell lung cancer.Combining the safety,effectiveness,and economic evaluation results to provide a decision-making reference for clinical rational drug use.Research methods:1.Meta analysis: search for databases such as Pub Med,The Cochrance Library,Web of Science,CNKI,VIP and Wan Fang Data,using "Aidi","Gefitinib" and "Iressa" as keywords Published a randomized controlled clinical trial of gefitinib combined with Aidi injection in the treatment of non-small cell lung cancer.The search period was from the establishment of the database to December 2019.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,evaluated the quality of the included literature and extracted data,and used Rev Man5.3 software to conduct safety and effectiveness evaluation.2.Introduce the Markov model to evaluate the long-term economics of the two treatment options: from the perspective of patient payment,set the payment threshold(WTP)at 3 times the 2019 national per capita GDP,and establish a Markov three-state transfer model for non-small cell lung cancer.The published clinical research data and the medical price of a top three hospital in Guangzhou City determine the cost of the unprogressed period;the average cost of the progressed period is estimated from the literature;According to the literature clinical research effect data,the transfer probability is calculated and calibrated based on the DEALE principle;the health utility value refers to foreign countries Literature research results;The determined parameters are input into the Markov model established by the Tree Age pro 2011 software,and the software is run for roll back,queue simulation,and Monte Carlo simulation.Finally,deterministic and probabilistic sensitivity analysis is carried out to check the stability of each parameter to the output of the model.Result:Meta analysis: 9 RCTs were finally included,including a total of 584 patients.Meta analysis results showed that the recent effective rate of gefitinib combined with Aidi injection group was higher than that of gefitinib single use group [RR = 1.61,95% CI(1.31,1.98),P<0.0001] The control rate was higher than that in the single-use group [RR = 1.31,95% CI(1.20,1.43),P <0.00001],and the differences in treatment options between the two groups were statistically significant.Adverse reactions: The incidence of acne-like rash in the combined Aidi group was lower than that in the gefitinib alone group [RR = 0.75,95% CI(0.60,0.94),P = 0.01],the difference was statistically significant.In terms of itchy skin,dry skin,nausea and vomiting,oral mucositis,and diarrhea,there was no significant difference in the incidence of adverse reactions between the two groups.Long-term economic analysis: The result of multiplication analysis shows that the cost-effective ratio of gefitinib alone is 921.16 yuan/QALM,and the combined cost-effective ratio of Aidi injection is 9876.01 yuan/QALM,incremental cost-effective ratio(ICER)is12299.78 yuan,less than the payment threshold(17723 yuan/month),that is,the gefitinib combined with Aidi injection solution is more economical than the gefitinib single-use group.One-dimensional sensitivity analysis showed that when the probability of metastasis from the combination of Aidi's plan did not progress to the non-progressive stage was greater than0.8402,the combination of Aidi's injection treatment program benefited more.Probability sensitivity analysis shows that when the payment threshold is 17,723 yuan/month,the probability of Gefitinib combined with the Aidi group is more than 95.15%.When WTP is reduced to less than 14,000 yuan/month,the probability of gefitinib alone is more than 50%economical.Conclusion:Under the national level standard,from the perspective of patients,with 3 times the per capita GDP in 2019 as the payment threshold,the combination of gefitinib and Eddie compared with the gefitinib single-use program has certain safety,effectiveness,and economic aspects.The advantages.