Cost-effectiveness of edaravone dexborneol versus dl-3-n-butylphthalide for the treatment of acute ischemic stroke: a Chinese health care perspective

Abstract

Background: Edaravone dexborneol and dl-3-n-butylphthalide are two innovative brain cytoprotective drugs from China that have been approved and widely prescribed for acute ischemic stroke, and the cost of the two drugs are partially paid by the Chinese medical insurance system. This study aimed to investigate and compare the cost-effectiveness of edaravone dexborneol versus dl-3-n-butylphthalide for acute ischemic stroke from the Chinese healthcare system’s perspective. Methods: A model combining a short-term decision tree model with 90 days and a long-term Markov model with a life-time horizon (40 years) was developed to simulate the cost-effectiveness of edaravone dexborneol versus dl-3-n-butylphthalide for acute ischemic stroke over a lifetime horizon. Since the absence of a head-to-head clinical comparison of two therapies, an unanchored matching-adjusted indirect comparison (MAIC) was conducted by adjusting the patient characteristics using individual patient data from pivotal phase III trial of edaravone dexborneol and published aggregated data of dl-3-n-butylphthalide. Health outcomes were measured in quality-adjusted life years (QALYs). Utilities and costs (Chinese Yuan, CNY) were derived from publications and open-access database. One-way and probabilistic sensitivity analyses were performed to evaluate the robustness of results. Results: Compared with patients in dl-3-n-butylphthalide arm, edaravone dexborneol arm was found to be cost-effective in 90 days and highly cost-effective as the study horizons extended. With a similar direct medical cost, patients in edaravone dexborneol arm slightly gained an additional 0.1615 QALYs in life-time. In the long term (40 years), patients in edaravone dexborneol arm and dl-3-n-butylphthalide arm yielded 8.0351 and 7.8736 QALYs with the overall direct medical cost of CNY 29,185.23 and CNY 29,940.28, respectively. The one-way sensitivity analysis suggested that the incremental cost-effectiveness ratio was most sensitive to the price of edaravone dexborneol and dl-3-n-butylphthalide. Conclusion: Edaravone dexborneol is a cost-effective alternative compared with dl-3-n-butylphthalide for acute ischemic stroke patients in current medical setting of China.

Efficacy, safety, and cost-effectiveness analysis of Cerebrolysin in acute ischemic stroke: A rapid health technology assessment

“…After layer-by-layer screening according to the inclusion and exclusion criteria, a final set of 14 articles was included, including 8 SR or meta-analysis [15][16][17][18][19][20][21][22] and 6 pharmacoeconomic studies. [25][26][27][28][29][30] No HTA report was retrieved. The literature screening process and results are provided in Figure 1.…”

“…The complete coincidence rate = number of conducted entries/ (the total number of evaluation entries − number of un-applicable entries)*100% Li G 2013 [27] China Not reported…”

“…Lin WS 2004 [25] Zhang GX 2010 [26] Li G 2013 [27] Men P 2016 [28] He X 2017 [29] Strilciuc S 2023 [30] 1 Conducted (C): The report content adheres to the standard of a specific item on the CHEERS 2022 checklist; Partially conducted (PC): The report content is not comprehensive and partially adheres to the standard of a specific item on the CHEERS 2022 checklist; Not reported (NR): The report content does not comply with the standard of a specific item on the CHEERS 2022 checklist; Not applicable (NA):…”

“…However, related studies indicate its cost-effectiveness falls short of Edaravone injection and Gangliosides. [26,27]…”