Strilciuc Stefan, Radu Constantin, Grad Diana-Alecsandra, Stan Adina Dora, Vladescu Cristian, Buzoianu Anca Dana, Muresanu Dafin
Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
RoNeuro Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania.
Healthcare (Basel). 2023 May 21;11(10):1497. doi: 10.3390/healthcare11101497.
The cost-effectiveness of Cerebrolysin as an add-on therapy for moderate-severe acute ischemic stroke is a topic that remains understudied. This study aims to address this gap by performing a comprehensive cost-utility analysis using both deterministic and probabilistic methods from a payer perspective and within the Romanian inpatient care setting. Quality-adjusted life years (QALYs) were calculated using partial individual patient data from the 2016 Cerebrolysin and Recovery After Stroke (CARS) trial, utilizing three different health state valuation models. Cost data was extracted from actual acute care costs reported by Romanian public hospitals for reimbursement purposes for patients included in the CARS study. Incremental cost-effectiveness ratios were calculated for each treatment arm for the duration of the clinical trial. Deterministic analysis based on sample mean values indicates Cerebrolysin would be cost-effective at a threshold between roughly 18.8 and 29.9 thousand EUR, depending on valuation techniques. Probabilistic sensitivity analysis results indicate an 80% chance probability of cost-effectiveness of Cerebrolysin as an add-on therapy for acute ischemic stroke, considering a willingness-to-pay threshold of 50,000 EUR in a 90-day timeframe after stroke. Further economic evaluations of Cerebrolysin are needed to strengthen these findings, covering a timeframe of at least 12 months after the acute incident, which would account for treatment effects spanning beyond the first 90 days after ischemic stroke. These should be conducted to determine its cost-effectiveness under various care settings and patient pathways. Most importantly, modelling techniques are needed to answer important questions such as the estimates of population gain in QALYs after acute administration of Cerebrolysin and the potential offsetting of direct medical costs as a result of administering the intervention.
脑蛋白水解物作为中重度急性缺血性中风附加治疗的成本效益是一个仍未得到充分研究的课题。本研究旨在通过从支付方角度并在罗马尼亚住院护理环境中使用确定性和概率性方法进行全面的成本效用分析来填补这一空白。使用来自2016年脑蛋白水解物与中风后恢复（CARS）试验的部分个体患者数据，利用三种不同的健康状态估值模型计算质量调整生命年（QALYs）。成本数据从罗马尼亚公立医院为CARS研究中纳入的患者报销目的报告的实际急性护理成本中提取。在临床试验期间，为每个治疗组计算增量成本效益比。基于样本均值的确定性分析表明，根据估值技术，脑蛋白水解物在大约1.88万至2.99万欧元之间的阈值下具有成本效益。概率敏感性分析结果表明，考虑到中风后90天内5万欧元的支付意愿阈值，脑蛋白水解物作为急性缺血性中风附加治疗具有成本效益的概率为80%。需要对脑蛋白水解物进行进一步的经济评估，以加强这些发现，涵盖急性事件后至少12个月的时间范围，这将考虑到缺血性中风后前90天之外的治疗效果。应进行这些评估，以确定其在各种护理环境和患者路径下的成本效益。最重要的是，需要建模技术来回答重要问题，例如急性给予脑蛋白水解物后QALYs中人群获益的估计以及由于实施干预而导致的直接医疗成本的潜在抵消。
