Shi Fenghao, He Zixuan, Wang Lin, Su Hang, Han Sheng
International Research Center for Medicinal Administration, Peking University, Beijing, China.
School of Pharmaceutical Sciences, Peking University, Beijing, China.
Front Pharmacol. 2022 Oct 18;13:938239. doi: 10.3389/fphar.2022.938239. eCollection 2022.
The TASTE trial indicated that patients with acute ischemic stroke (AIS) using edaravone dexborneol have a significantly higher proportion of 90-day good functional outcomes (mRS 0-1) than those using edaravone. This study compared the cost-effectiveness of the aforementioned interventions in treating AIS in the Chinese setting, aiming to inform treatment decisions in clinical practice. A model combining a decision tree and a Markov model was developed to assess the cost-effectiveness of edaravone dexborneol edaravone for AIS over a 30-year time horizon from the Chinese healthcare system's perspective. Both efficacy and safety data were extracted from the TASTE study. Local costs and utilities were derived from publications and open-access databases; both cost and effectiveness were discounted at a rate of 5% per year. Sensitivity analyses were conducted to ensure robustness and identify the main drivers of the result. Compared with edaravone, edaravone dexborneol for AIS was found to be cost-effective in the first year and highly cost-effective as the study time horizons extended. In the long term (30 years), edaravone dexborneol yielded a lifetime gain of 0.25 (0.07-0.45) quality-adjusted life years (QALYs) at an additional cost of CNY 2201.07 (-3,445.24-6,637.23), yielding an ICER of CNY 8823.41 per QALY gained under the willingness-to-pay (WTP) of 1.5 times per capita GDP (121,464 CNY). The result is robust in both deterministic and probabilistic sensitivity analysis (PSA) methods, with the advantage of the edaravone dexborneol strategy increasing over time. Specifically, the probability of edaravone dexborneol dominant dexborneol is 76.30%, 98.90%, and 99.50% over 1-, 5-, and 30-year time horizons. Both short- and long-term economic analyses suggest that edaravone dexborneol is highly likely to be a cost-effective alternative to treat AIS compared with edaravone in China.
TASTE试验表明,与使用依达拉奉的急性缺血性卒中(AIS)患者相比,使用依达拉奉右莰醇的患者90天功能良好结局(改良Rankin量表评分0 - 1分)的比例显著更高。本研究比较了上述干预措施在中国治疗AIS的成本效益,旨在为临床实践中的治疗决策提供参考。构建了一个结合决策树和马尔可夫模型的模型,从中国医疗保健系统的角度评估依达拉奉右莰醇和依达拉奉治疗AIS在30年时间范围内的成本效益。疗效和安全性数据均取自TASTE研究。当地成本和效用值来自出版物和开放获取数据库;成本和效果均按每年5%的贴现率进行贴现。进行了敏感性分析以确保结果的稳健性并确定结果的主要驱动因素。与依达拉奉相比,发现依达拉奉右莰醇在第一年具有成本效益,并且随着研究时间范围的延长具有高度成本效益。从长期(30年)来看,依达拉奉右莰醇每增加2201.07元(-3445.24 - 6637.23元)的成本可带来0.25(0.07 - 0.45)个质量调整生命年(QALY)的终生获益,在支付意愿为人均GDP的1.5倍(121464元)的情况下,每获得一个QALY的增量成本效益比为8823.41元。该结果在确定性和概率性敏感性分析(PSA)方法中均稳健,且依达拉奉右莰醇策略的优势随时间增加。具体而言,在1年、5年和30年的时间范围内,依达拉奉右莰醇优于依达拉奉的概率分别为76.30%、98.90%和99.50%。短期和长期经济分析均表明,在中国,与依达拉奉相比,依达拉奉右莰醇极有可能是治疗AIS的一种具有成本效益的替代方案。