Academic Pharmacist - Graduate School of Health, University of Technology Sydney, Broadway, New South Wales 2007, Australia; Research Affiliate - Hunter Medical Research Institute, New South Wales, Australia.
Senior Lecturer - Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria 3127, Australia.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105213. doi: 10.1016/j.jstrokecerebrovasdis.2020.105213. Epub 2020 Aug 8.
In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes.
This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data.
A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs.
Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 - 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit.
Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors.
在中风幸存者中，中风后疲劳可预测日常生活中的依赖和无法重返工作岗位。莫达非尼作为一种治疗中风后疲劳的药物疗法具有一定的前景，可以减少中风后疲劳及相关后遗症，例如较差的功能和临床结局。
本研究通过对 MIDAS 试验数据的重新分析，确定莫达非尼治疗中风后疲劳在澳大利亚的成本效益，计算其增量成本效益比（ICER），并模拟在全国范围内可能节省的成本。
进行了一项事后成本效益分析。第 A 部分：从健康系统的角度出发，从 MIDAS 试验中获得患者层面的成本和健康效果数据（多维疲劳量表（MFI）评分）。第 B 部分：二次分析模拟了莫达非尼治疗对国家生产力成本的影响。
第 A 部分：莫达非尼治疗的平均成本为每位患者每天 3.60 澳元，可使总 MFI 疲劳评分发生最小临床意义变化（10 分），即每位患者的疲劳评分每变化 1 分，成本增加 0.36 澳元/天/单位。对于基础情况，使用莫达非尼（与安慰剂相比）的 ICER 为 131.73 澳元（90.17-248.15 澳元，最低和最高成本）。第 B 部分：在澳大利亚有劳动能力的中风幸存者人群中广泛使用莫达非尼治疗，预计在 1 年内可为社会节省近 4670 万澳元，在 10 年内可节省 383471991248 澳元，这是社会效益的显著体现。
莫达非尼是治疗中风后疲劳的一种非常具有成本效益的方法，在澳大利亚有劳动能力的中风幸存者人群中广泛使用莫达非尼治疗，可带来显著的生产力提高和社会效益。
