Efficacy And Cost-effectiveness Analysis Of The Second-line Treatment For Advanced Non-small-cell Lung Cancer

Objective: There are four drugs commonly used in second-line treatment for advanced non-small-cell lung cancer include TXT,Pemetrexed,Erlotinib and Gefitinb. To analyze the Cost-effectiveness of the four chemotherapies by therapeutic effect,drug-cost and clinic benefit-ratio.Methods: 160 patients of NSCLC (ⅢB,Ⅳ) were assigned to TXT, Pemetrexed , Erlotinib or Gefitinb groups who were admission to Dalian Medical University Affiliated Hospital between April 2006 and April 2010. According to RECIST to evaluate the effectiveness of 160 patients by iconography and physico-chemical test every 6 weeks and devide into CR,PR,SD or PD. Investigating the adverse reaction occurred in patients by NCI. Calculating the total cost of each patient and comparing the PFS to discuss the Cost-effectiveness ratio amongst four therapy groups.Results: Evaluating 160 patients in four group(TXT, Pemetrexed , Erlotinib and Gefitinb).The RR were 7.5%,10%,20%,22.5%; the DCR were 32.5%, 50%, 65%, 52.5%; the mPFS were 2.7months, 2.8months,3.5months,3.5months respectively. The difference of objective effectiveness rate and disease control rate showed in sex, age, KPS score, pathology have no statistically significant. Log-rank univariate survival analysis showed the difference of four scheme in mPFS have no statistically significant yet. Adverse drugs reactions(ADR) caused by chemotherapeutics TXT and Pemetrexed wereⅠ,Ⅱhematotoxicity and gastrointestinal reaction, while the adverse reactions caused by targeted therapy drugs Erlotinib and Gefitinb wereⅠ,Ⅱerythra and gastrointestinal reaction. The people who caplendus TXT had the most seriousⅢ,Ⅳadverse reactions and had the worst tolerance. The result compare to the Pemetrexed had statistically significant. The other 2 group had no statistically significant inⅢ,Ⅳadverse reactions. All patients had not suffered interstitial pneumonia and they had not reduced drug does or withdrawal. For the four groups, the cost of per unit ( 1 month) increasing of PFS need 5635.56 yuan,10279.62 yuan,20813.96 yuan,17587.76 yuan respectively. The scheme TXT had the lowest cost-effectiveness rate .On the basis of scheme TXT, scheme Pemetrexed, scheme Erlotinib, scheme Gefitinb need to add to the cost 46434.69 yuan,119060.49 yuan,98897.68 yuan respectively to increase one unit PFS(1month). Sensitivity analysis showed that this cost - benefit results are reliable.Conclusion:The research show that the second-line drugs(TXT, Pemetrexed , Erlotinib and Gefitinb) used for NSCLC had no statistically significant in their mPFS but had obvious difference in cost and adverse reactions. The scheme TXT had the lowest cost but with severe ADR. The scheme Erlotinib and scheme Gefitinb had minor ADR but with the most expensive cost. The cost and ADR of scheme Pemetrexed are between foregoing two groups. Patients and medical staff can choose suitable treatment according to the actual situation of the patients to achieve the individual purpose.