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Introduction <p>Lung cancer remains a leading cause of cancer-related morbidity and mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for &gt; 85% of cases. Traditional Chinese Medicine (TCM) has played an integral role in NSCLC management, particularly in combination with chemotherapy. Although the safety and efficacy of TCM injections have been widely studied, comprehensive pharmacoeconomic evaluations remain limited.</p> Aim <p>This review aimed to evaluate the safety, efficacy, and cost-effectiveness of five TCM injections, Marsdenia tenacissima, Aidi, Kanglaite, Kangai, and Shenqi Fuzheng, in combination with chemotherapy for the treatment of advanced NSCLC.</p> Method <p>A systematic literature review identified 165 randomized controlled trials (RCTs) published between 2000 and 2024. A Bayesian network meta-analysis (NMA) was performed to compare the objective response rates (ORR) and adverse events (AEs) among the five TCM injections plus chemotherapy versus chemotherapy alone. A decision tree model with a 6-month time horizon was constructed from the healthcare system perspective, incorporating direct medical costs, including drug administration, monitoring, and AE management. The incremental cost-effectiveness ratios (ICERs) were calculated based on incremental ORR improvements. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model.</p> Results <p>All five TCM injections combined with chemotherapy demonstrated superior ORR compared with chemotherapy alone. Kanglaite injection showed the highest ORR improvement (12.5%) and lowest incidence of leukopenia and hepatic dysfunction. However, Kangai injection exhibited the lowest ICER of $19.56 per 1% ORR gain, indicating the highest cost-effectiveness. The ICERs for the remaining regimens were $43.38 (Marsdenia tenacissima), $29.68 (Aidi), $56.94 (Kanglaite), and $28.08 (Shenqi Fuzheng) per 1% ORR. Sensitivity analyses confirmed the robustness of these findings, with ORR and injection costs identified as the key drivers.</p> Conclusion <p>Among the five TCM injections evaluated, Kangai injection combined with chemotherapy has emerged as the most cost-effective regimen for advanced NSCLC. These findings support the integration of TCM into evidence-based cancer care, and highlight the need for further pharmacoeconomic research, particularly in real-world clinical settings.</p>

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Economics, efficacy and safety of five traditional Chinese medicine injections plus chemotherapy as adjuvant therapy for non-small cell lung cancer: A network meta-analysis

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Kai Xu,
  • Hongtao Li,
  • Yulu Zhu,
  • Zhuying Jing,
  • Lihong Gao,
  • Yuyang Sun,
  • Baolong Ding,
  • Hongting Yao,
  • Hui Wang,
  • Xin Li

摘要

Introduction

Lung cancer remains a leading cause of cancer-related morbidity and mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for > 85% of cases. Traditional Chinese Medicine (TCM) has played an integral role in NSCLC management, particularly in combination with chemotherapy. Although the safety and efficacy of TCM injections have been widely studied, comprehensive pharmacoeconomic evaluations remain limited.

Aim

This review aimed to evaluate the safety, efficacy, and cost-effectiveness of five TCM injections, Marsdenia tenacissima, Aidi, Kanglaite, Kangai, and Shenqi Fuzheng, in combination with chemotherapy for the treatment of advanced NSCLC.

Method

A systematic literature review identified 165 randomized controlled trials (RCTs) published between 2000 and 2024. A Bayesian network meta-analysis (NMA) was performed to compare the objective response rates (ORR) and adverse events (AEs) among the five TCM injections plus chemotherapy versus chemotherapy alone. A decision tree model with a 6-month time horizon was constructed from the healthcare system perspective, incorporating direct medical costs, including drug administration, monitoring, and AE management. The incremental cost-effectiveness ratios (ICERs) were calculated based on incremental ORR improvements. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model.

Results

All five TCM injections combined with chemotherapy demonstrated superior ORR compared with chemotherapy alone. Kanglaite injection showed the highest ORR improvement (12.5%) and lowest incidence of leukopenia and hepatic dysfunction. However, Kangai injection exhibited the lowest ICER of $19.56 per 1% ORR gain, indicating the highest cost-effectiveness. The ICERs for the remaining regimens were $43.38 (Marsdenia tenacissima), $29.68 (Aidi), $56.94 (Kanglaite), and $28.08 (Shenqi Fuzheng) per 1% ORR. Sensitivity analyses confirmed the robustness of these findings, with ORR and injection costs identified as the key drivers.

Conclusion

Among the five TCM injections evaluated, Kangai injection combined with chemotherapy has emerged as the most cost-effective regimen for advanced NSCLC. These findings support the integration of TCM into evidence-based cancer care, and highlight the need for further pharmacoeconomic research, particularly in real-world clinical settings.