Xie Yu, Hu Liping, Xu Ping, Guo Xianbin, Cai Junxiu, Pan Min, Tang Jie, Gong Qingtao, Su Rong, Lou Yake, Liu Yan, Wang Li, Yu Ying
Department of Neurology, Zigong Third People's Hospital, Zigong, Sichuan, China.
Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China.
Front Pharmacol. 2025 Apr 3;16:1470373. doi: 10.3389/fphar.2025.1470373. eCollection 2025.
Studies have shown that argatroban improves 90-day functional outcomes in patients with acute ischemic stroke (AIS) with early neurological deterioration (END). However, its cost-effectiveness in this patient population remains unclear.
A combination of a short-term decision tree and a long-term Markov model was developed to calculate the total cost and effectiveness for Chinese patients with AIS with END treated with intravenous argatroban plus standard therapy or standard therapy alone. Cost data were accessed from our institution, the China National Stroke Registry, and other public sources, while effectiveness data were obtained from the EASE trial and the China Health Statistical Yearbook 2022. The primary outcome was the incremental cost-effectiveness ratio (ICER), with secondary outcomes including total cost, total effectiveness, and incremental effectiveness. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were performed to assess certainty, uncertainty, and robustness.
For Chinese patients with AIS with END, treatment combining argatroban with standard therapy resulted in a lifetime cost of 138,812 Chinese Yuan (CNY), compared to 136,353 CNY for standard therapy alone. The combined treatment achieved 4.19 quality-adjusted life years (QALYs) (equivalent to 8.43 life years), while standard therapy yielded 3.78 QALYs (equivalent to 8.17 life years). This led to an ICER of 5968 CNY per QALY (9367 CNY per life year), below the willingness-to-pay threshold. One-way sensitivity analysis indicated that argatroban's efficacy was the primary driver of the ICER, consistently remaining below the threshold. PSA showed that argatroban was highly cost-effective in over 99% of cases and dominant in 0.54% of cases. Scenario analysis confirmed the robustness of these findings across various scenarios.
Argatroban is highly cost-effective for Chinese patients with AIS and END from the perspective of the Chinese healthcare system.
研究表明，阿加曲班可改善急性缺血性卒中（AIS）伴早期神经功能恶化（END）患者的90天功能结局。然而，其在该患者群体中的成本效益仍不明确。
构建短期决策树和长期马尔可夫模型相结合的模型，以计算接受静脉注射阿加曲班联合标准治疗或仅接受标准治疗的中国AIS伴END患者的总成本和有效性。成本数据来自我们的机构、中国国家卒中登记系统及其他公共来源，而有效性数据则取自EASE试验和《2022年中国卫生统计年鉴》。主要结局为增量成本效益比（ICER），次要结局包括总成本、总有效性和增量有效性。进行单向敏感性分析、概率敏感性分析和情景分析，以评估确定性、不确定性和稳健性。
对于中国AIS伴END患者，阿加曲班联合标准治疗的终身成本为138,812元人民币（CNY），而仅标准治疗的成本为136,353元人民币。联合治疗实现了4.19个质量调整生命年（QALY）（相当于8.43个生命年），而标准治疗产生了3.78个QALY（相当于8.17个生命年）。这导致ICER为每QALY 5968元人民币（每生命年9367元人民币），低于支付意愿阈值。单向敏感性分析表明，阿加曲班的疗效是ICER的主要驱动因素，始终低于阈值。概率敏感性分析显示，阿加曲班在超过99%的情况下具有高成本效益，在0.54%的情况下占主导地位。情景分析证实了这些发现在各种情景下的稳健性。
从中国医疗保健系统的角度来看，阿加曲班对中国AIS伴END患者具有高成本效益。
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