The Systematic Review Of Pemetrexed Versus Docetaxel In Second-line Chemotherapy With Non-small Cell Lung Cancer

Objectives To systematically review the efficacy,safety and economy of pemetrexed versus docetaxel in second-line chemotherapy with NSCLC.To analysis the economy of pemetrexed and docetaxel for advanced Ns-NSCLC patients in order to conduct the proper clinical application and improve the use of medical resources.Methods 1.According to the PICOS,the search strategy was set to search Pubmed,EMBASE,the Cochrane Library,Wanfang database,CNKI and VIP database to assess the efficacy and safety of pemetrexed and docetaxel in second-line chemotherapy with advanced NSCLC patients by meta-analysis.2.Depend on the Chiou CF Instrument,the economy between pemetrexed and docetaxel in second-line chemotherapy with advanced NSCLC patients was evaluated by a systematic review.3.Base on the data from RCT and medical system of China,a three-state Markov model was built in Tree Age pro to simulate the process of advanced Ns-NSCLC from the perspective of Chinese healthcare system.LYG,QALY and ICER were used as evaluation indicators.Base analysis was performed to analysis the cost-utility between pemetrexed and docetaxel.One-way sensitivity and probability sensitivity analyses were performed to allow for uncertainties within the model parameters and to estimate the model's robustness.Results 1.23 RCTs were included in Meta-analysis.8 RCTs explored the clinical outcomes of Ns-NSCLC.Compared to docetaxel,pemetrexed improved OS significantly(HR=-0.248;95%CI-0.493,-0.004;P=0.047)in advanced Ns-NSCLC patients,with fewer ADRs.2.12 literatures were included in systematic review.Within the WTP of some developing countries,docetaxel was much more cost-effectiveness.While within the WTP of some developed countries,pemetrexed was a cost-effective strategy.3.The model was run 52 cycles.The result of base analysis showed that the patients received pemetrexed gained 0.141 QALYs.The ICER was 129454.17RMB/QALY,that is,pay 129454.17 RMB for one more QALY,which was less than 3×GDP per capita.The model was robust to key parameters in both one-way sensitivity analysis and probability sensitivity analysis but sensitive to the chemotherapy cost of pemetrexed.Conclusions 1.Effect evaluation shows that the efficacy outcomes have no significant difference between pemetrexed and docetaxel in second-line chemotherapy with advanced NSCLC.Pemetrexed improved OS in second-line chemotherapy with advanced Ns-NSCLC compared to docetaxel.2.Safety evaluation shows that pemetrexed has significantly fewer ADRs rates in second-line chemotherapy with advanced Ns-NSCLC compared to docetaxel.3.Economy evaluation shows that from a Chinese health system perspective,pemetrexed was more cost-effective compared with docetaxel,using the thresholds that were 3 times per capital GDP in China.