The efficacy of Endostar combined with platinum pleural infusion for malignant pleural effusion in tumor patients is significantly better than that of monotherapy, but the economy is lower: a systematic review, network meta-analysis and cost-effectiveness analysis

BACKGROUND: Endostar and platinum were widely used in the treatment of malignant pleural effusion (MPE), but there was no unified conclusion on which scheme is the best. The aim of this study was to systematically evaluate the efficacy and cost-effectiveness of Endostar, cisplatin, lobaplatin, Endostar combined with cisplatin, and Endostar combined with lobaplatin in the treatment of MPE so as to provide a reference for clinical treatment. METHODS: A comprehensive literature search was performed of sources on PubMed, Web of Science, and other databases published up to and including November 23, 2021, and screened out randomized controlled trial (RCT) concerning the efficacy of 5 interventions of pleural perfusion for MPE. The Cochrane Collaboration tool was used for assessing the risk of bias, and a network meta-analysis was performed with Addis software based on the Bayesian framework. A decision tree model was used to complete a cost-effectiveness analysis that was based on the direct medical costs and the probabilities were determined from the network meta-analysis. The one-way sensitivity analysis was presented with a tornado chart. In the probabilistic sensitivity analysis, the cost-effectiveness acceptability curve was obtained after Monte Carlo simulation. RESULTS: A total of 55 studies were included, comprising 3,379 total patients, excluding the unclear part, we evaluated as low risk of bias. According to the network meta-analysis, Endostar combined with lobaplatin had the highest effectiveness, followed by Endostar combined with cisplatin, Endostar, cisplatin, and lobaplatin. In the incremental cost-effectiveness ratio (ICER) analysis, lobaplatin and Endostar were excluded as inferior schemes. With cisplatin as the comparison, the ICER of Endostar combined with cisplatin was yuan renminbi ¥22,648.31. With Endostar combined with cisplatin as the comparison, the ICER of Endostar combined with lobaplatin was ¥236,502.67. The results of sensitivity analysis and cost-effectiveness analysis were basically consistent. CONCLUSIONS: Endostar combined with lobaplatin had the highest effectiveness, but its ICER was relatively too high to be acceptable. Therefore, cisplatin alone and Endostar combined with cisplatin were more cost-effective, and clinicians can choose the optimal treatment scheme based on the willingness to pay (WTP) of different patients with comprehensive consideration of effectiveness and economy.