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Han L, Lan K, Kou D, Meng Z, Feng J, Maitland E, Nicholas S, Wang J. Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula. HEALTH ECONOMICS REVIEW 2024; 14:37. [PMID: 38836982 PMCID: PMC11154974 DOI: 10.1186/s13561-024-00513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China. METHOD We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model. RESULTS EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER. CONCLUSIONS EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.
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Affiliation(s)
- Lu Han
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Kuixu Lan
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dejian Kou
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Zehua Meng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jin Feng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, England, United Kingdom
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, NSW, Australia
| | - Jian Wang
- Center for Health Economics and Management, School of Economics and Management, Wuhan University, Wuhan, China.
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Chen P, Luo M, Chen Y, Zhang Y, Wang C, Li H. Cost-effectiveness of edaravone dexborneol versus human urinary kallidinogenase for acute ischemic stroke in China. HEALTH ECONOMICS REVIEW 2024; 14:7. [PMID: 38285185 PMCID: PMC10823610 DOI: 10.1186/s13561-024-00479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Clinical trials have demonstrated the efficacy of edaravone dexborneol in the treatment of acute ischemic stroke. This study aims to determine the cost-effectiveness of edaravone dexborneol compared with human urinary kallidinogenase from China's healthcare system perspective. METHODS A combination of the decision tree and Markov model was constructed to evaluate the cost-effectiveness of edaravone dexborneol versus human urinary kallidinogenase in the treatment of acute ischemic stroke over a lifetime horizon. Efficacy data were derived from pivotal clinical trials of edaravone dexborneol and human urinary kallidinogenase (TASTE trial and RESK trial, respectively) and adjusted using matching-adjusted indirect comparison. Cost and health utility inputs were extracted from published literature and open databases. One-way deterministic sensitivity and probabilistic sensitivity analyses were performed to examine the robustness of the results. RESULTS Compared with human urinary kallidinogenase, edaravone dexborneol generated 0.153 incremental quality-adjusted life years (QALYs) with an incremental cost of ¥856, yielding an incremental cost-effectiveness ratio of ¥5,608 per QALY gained under the willingness-to-pay threshold (one-time gross domestic product per capita). Both one-way deterministic sensitivity analysis and probabilistic sensitivity analysis demonstrated the robustness of the base case results. CONCLUSIONS Edaravone dexborneol is a cost-effective treatment choice for acute ischemic stroke patients compared with human urinary kallidinogenase in China.
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Affiliation(s)
- Pingyu Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Road, Jiangning District, Nanjing, 211198, Jiangsu Province, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Mengjie Luo
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Road, Jiangning District, Nanjing, 211198, Jiangsu Province, China
| | - Yanqiu Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Road, Jiangning District, Nanjing, 211198, Jiangsu Province, China
| | - Yanlei Zhang
- State Key Laboratory of Neurology and Oncology Drug Development (Jiangsu Simcere Pharmaceutical Co.,Ltd., Jiangsu Simcere Diagnostics Co.,Ltd.), Nanjing, Jiangsu, China
| | - Chao Wang
- State Key Laboratory of Neurology and Oncology Drug Development (Jiangsu Simcere Pharmaceutical Co.,Ltd., Jiangsu Simcere Diagnostics Co.,Ltd.), Nanjing, Jiangsu, China
| | - Hongchao Li
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Road, Jiangning District, Nanjing, 211198, Jiangsu Province, China.
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu, China.
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Xia H, Yang Q, Wang Q, Jia J, Liu X, Meng S. Economic evaluation of stent retrievers in basilar artery occlusion: An analysis from Chinese healthcare system perspective. PLoS One 2023; 18:e0294929. [PMID: 38033030 PMCID: PMC10688905 DOI: 10.1371/journal.pone.0294929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE This study aimed to investigate the cost-effectiveness of stent retriever (SR) versus best medical management (BMM) in patients with basilar artery occlusion (BAO) in China. METHODS We used a two-step approach to compare the cost-effectiveness of SR plus BMM with that of BMM alone over 20 years. A decision tree was initially constructed for the first 3 months, followed by a Markov model for the subsequent period. Collected data on clinical aspects were extracted from the BAOCHE investigation, while costs-related information was sourced from previously published research. The key metric for evaluating the primary outcome was the incremental cost-effectiveness ratio (ICER), achieved $/QALY. The threshold for identifying SR as highly cost-effective was set at an ICER below $12,551/QALY, SR was deemed cost-effective if the ICER ranged from $12,551 to $37,654 per QALY. Uncertainty was addressed using scenario, one-way sensitivity, and probabilistic sensitivity analyses (PSA). FINDINGS For Chinese patients with BAO, the 20-year cost per patient was $8678 with BMM alone and $21,988 for SR plus BMM. Effectiveness was 1.45 QALY for BMM alone, and 2.77 QALY for SR plus BMM. The ICER of SR + BMM versus BMM alone was $10,050 per QALY. The scenario and one-way sensitivity analyses revealed that in certain situations the ICER could exceed $12,551 per QALY, but remain below $37,654 per QALY. Results from the PSA suggested that SR was likely to be cost-effective for Chinese patients with BAO, with a probability exceeding 98% when considering a willingness-to-pay (WTP) threshold of $12,551 per QALY. IMPLICATIONS Our study indicates that SR is an intervention option that is highly likely to be cost-effective for Chinese patients with BAO, with a probability of over 98% under the current WTP threshold of $12,551 per QALY.
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Affiliation(s)
- Hailong Xia
- Department of Neurosurgery, Chongqing Red Cross Hospital(Jiangbei District People’s Hospital), Chongqing, China
| | - Qi Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibo Wang
- Department of Neurosurgery, Chongqing Red Cross Hospital(Jiangbei District People’s Hospital), Chongqing, China
| | - Jielin Jia
- Department of Neurosurgery, Chongqing Red Cross Hospital(Jiangbei District People’s Hospital), Chongqing, China
| | - Xipeng Liu
- Department of Orthopaedic, Chongqing Red Cross Hospital(Jiangbei District People’s Hospital), Chongqing, China
| | - Shu Meng
- Internal medicine department, Chongqing Red Cross Hospital(Jiangbei District People’s Hospital), Chongqing, China
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Wang L, Yu Y, Zhou L, Xu P, Guo X, Xie Y, Cai J, Pan M, Tang J, Gong Q, Su R, Lou Y, Liu Y. Endovascular treatment for basilar artery occlusion: a cost-effectiveness analysis based on a meta-analysis. Front Neurol 2023; 14:1267554. [PMID: 37928158 PMCID: PMC10623329 DOI: 10.3389/fneur.2023.1267554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Objective This study aimed to investigate the efficacy and economic effect of endovascular treatment (EVT) combined with standard medical treatment (SMT) vs. SMT alone in Chinese patients with basilar artery occlusion (BAO) from the perspective of the Chinese healthcare system. Methods We conducted a cost-effectiveness analysis using the results from a meta-analysis comparing EVT and SMT efficacy in Chinese patients with BAO-induced stroke using direct medical costs from the China National Stroke Registry. The meta-analysis's primary outcome was excellent functional outcome (mRS scores of 0-2), with secondary outcomes being poor functional outcome (mRS scores of 3-5) and death (mRS score of 6). To compare EVT plus SMT's cost-effectiveness with that of SMT alone, we constructed a combined decision tree and Markov model with a lifetime duration and a 3-month cycle length. The primary cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost per incremental quality-adjusted life year (QALY). EVT was considered cost-effective if the ICER was lower than the willingness-to-pay (WTP) threshold of three times the per capita gross domestic product (GDP) in 2021 in China; otherwise, it would not be cost-effective. Results The meta-analysis results indicated that EVT could increase the incidence of excellent functional outcomes, with a risk ratio (RR) of 2.23 (95% confidence interval, CI, 1.18-4.21), p = 0.01. Simultaneously, EVT reduced the risk of poor functional outcome and mortality in the EVT group, with RRs of 0.83 (95% CI, 0.67-1.03), p = 0.09, and 0.71 (95% CI, 0.59-0.85), p = 0.0002, respectively. The study also found that EVT plus SMT resulted in a lifetime effectiveness of 2.15 QALY (3.88 life years) for 32,213 international dollars (Intl.$) per patient with BAO. In contrast, SMT alone achieved an effectiveness of 1.46 QALY (3.03 life years) with a total cost of Intl.$ 13,592 per patient. The ICER was Intl.$ 27,265 per QALY (Intl.$ 22,098 per life-year), which fell below the WTP threshold. Conclusion Compared to SMT, EVT improves the prognosis of BAO-induced stroke. Considering the Chinese healthcare system, adding EVT to SMT proves to be cost-effective for patients with BAO compared to SMT alone.
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Affiliation(s)
- Li Wang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Ying Yu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Limei Zhou
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Ping Xu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Xianbin Guo
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yu Xie
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Junxiu Cai
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Min Pan
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Jie Tang
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Qingtao Gong
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Rong Su
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
| | - Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Liu
- Department of Neurology, Zigong Third People’s Hospital, Zigong, China
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