Objective

2

To evaluate the clinical efficacy and economic value of the

Jiangsu Traditional Chinese Medicine （TCM） Diagnosis and Treatment Protocol for Dominant Diseases

（abbreviated as the

Diagnosis and Treatment Protocol

） in adult patients with non-severe community-acquired pneumonia （CAP） based on real-world clinical data.

Methods

2

A retrospective real-world cohort study was conducted using electronic medical records of adult patients hospitalized for non-severe CAP from September 1st， 2023 to December 31st， 2024 across 10 TCM hospitals in Jiangsu province. Patients were classified into an exposure group and a non-exposure group based on whether they received Chinese herbal medicine （CHM） according to the

Diagnosis and Treatment Protocol

. The non-exposure group received only conventional western medicine， while the exposure group additionally received differentiated CHM for at least five consecutive days. Outcomes were compared between two patient groups， including cough resolution rate， sputum resolution rate （assessed by volume， color， and consistency）， incidence of abnormal C-reactive protein （CRP）， incidence of abnormal white blood cell （WBC） count， and radiographic resolution rate of pulmonary infiltrates on chest imaging. Multivariable logistic regression was performed to identify factors influencing clinical efficacy. Subgroup analyses were conducted according to age， gender， smoking status， history of hypertension， and pneumonia severity score （CURB-65）， and the efficacy of treatment for cough and sputum was analyzed within each subgroup. Cost-effectiveness analysis was conducted using cough resolution rate as the outcome measure， evaluating the pharmacoeconomics of the two groups.

Results

2

A total of 1688 patients were included with 1293 in the exposure group and 395 in the non-exposure group. Compared to the non-exposure group， the exposure group demonstrated significantly higher resolutio

n rates of cough， sputum volume， color， and consistency， as well as a significantly lower incidence of abnormal CRP （

P

＜0.05）. No statistically significant difference was observed between the groups in terms of abnormal WBC count and radiographic resolution rate of pulmonary infiltrates （

P

＞0.05）. Logistic regression analysis showed that the cough resolution rate in the exposure group was 1.83 times that of the non-exposure group， while the probabilities of resolution in sputum volume， color， and consistency were 1.37， 2.09， and 1.56 times those of the non-exposure group， respectively （

P

＜0.05）. Subgroup analyses showed that the exposure group achieved significantly higher cough resolution rates across most subgroups except for populations with a CURB-65 score ≥2 or those with a history of hypertension （

P

＜0.05）. Specifically， among females， patients aged ≥18 and ＜65 years， non-smokers， those without hypertension， and those with a CURB-65 score of 0， the exposure group showed a higher cough resolution rate than the non-exposure group （

P

＜0.05）. From an economic perspective， total hospitalization cost， length of stay， antibiotic cost， and CHM cost all differed significantly between groups （

P

＜0.05）. The cost-effectiveness ratio （CER） was 10

788.80 CNY/case in the exposure group， while 22

513.80 CNY/case in the non-exposure group. This implies that， compared with the exposure group， the non-exposure group incurred an additional 17

302.27 CNY to achieve one case of cough resolution. When the willingness-to-pay threshold ranged from 0 to 50

000 CNY， the probability of economic advantage was consistently higher in the exposure group than in the non-exposure group.

Conclusion

2

On the basis of conventional western medicine， the addition of CHM in accordance with the

Diagnosis and Treatment Protocol

can effectively improve clinical symptoms， reduce inflammatory markers， promote cl

inical recovery， and is more cost-effective in treating adults with non-severe CAP.