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Cost-Effectiveness Analysis of Ginkgolide Injection in the Treatment of Ischemic Stroke Based on a Randomized
Yuliang Xiang1, Nan Yang1, Zhaoting Guo1
1Pharmaceutical Policy and Pharmacoeconomics Research Center, Sichuan University West China School of Pharmacy, Chengdu, China.
Insights
Ginkgolide plus aspirin is a cost-effective treatment for ischemic stroke in China, offering more quality-adjusted life-years (QALYs) at a cost below the national GDP threshold.
Area of Science:
- Pharmacoeconomics
- Neurology
- Traditional Chinese Medicine
Background:
- Stroke is a leading cause of death and disability in China.
- Chinese clinical guidelines recommend traditional patent medicines for acute ischemic stroke.
- Ginkgolide injection is widely used in China to improve blood circulation and treat stroke.
Purpose of the Study:
- To evaluate the long-term cost-effectiveness of ginkgolide plus aspirin versus placebo plus aspirin for ischemic stroke.
- To determine if ginkgolide injection is economically viable for stroke treatment in China.
Main Methods:
- A Markov model with four states (no disability, disability, recurrence, death) was used.
- Data from the Ginkgolide in Ischemic Stroke Patients with Large Artery Atherosclerosis (GISAA) study were utilized.
- Cost data were sourced from Chinese health statistics and hospital records; willingness-to-pay threshold set at 2019 Chinese per capita GDP.
Main Results:
- Ginkgolide plus aspirin resulted in higher costs but also higher quality-adjusted life-years (QALYs) compared to placebo plus aspirin.
- The incremental cost-effectiveness ratio (ICER) was CN¥14,866.06/QALY, falling below the willingness-to-pay threshold.
- Probabilistic sensitivity analysis indicated a higher acceptability of the ginkgolide plus aspirin treatment.
Conclusions:
- The addition of ginkgolides to conventional ischemic stroke treatment is cost-effective.
- Ginkgolide plus aspirin provides a favorable economic value at the Chinese per capita GDP threshold.
Abstract:
To evaluate the long-term cost-effectiveness of ginkgolide plus aspirin compared with placebo plus aspirin treatment of ischemic stroke. Stroke is the leading cause of death and long-term disability in China, with high incidence, high mortality, and heavy disease burden. In addition to Western medicines, Chinese clinical guidelines for diagnosis and treatment of acute ischemic stroke recommend application of Chinese patent medicines. Ginkgolide injection is commonly used in the clinical treatment of stroke in China to promote blood circulation and remove blood stasis. The economy of ginkgolide injection needs to be evaluated. A Markov model was constructed consisting of four disease states: no significant disability, disability, stroke recurrence, and death. Therapeutic data were taken from the Ginkgolide in Ischemic Stroke Patients with Large Artery Atherosclerosis (GISAA) study. Utilities and transition probabilities were extracted from the literature. Cost data were obtained from the China Health Statistics Yearbook and hospital record survey. Expected costs and quality-adjusted life-years (QALYs) of 13 years of cycles (calculated by average age of subjects and Chinese life expectancy) were calculated through TreeAge Pro11 software. The willingness-to-pay (WTP) threshold was set as the Chinese per capita Gross Domestic Product (GDP) in 2019, CN¥70,892/QALY. The results were analyzed by single factor and probability sensitivity analyses. Ginkgolide plus aspirin had a higher expected per-patient cost than placebo plus aspirin but a higher QALYs. Compared with placebo plus aspirin, ginkgolide plus aspirin produced an incremental cost-effectiveness ratio of CN¥14,866.06/QALY, which is below the WTP threshold. Probabilistic sensitivity analysis suggested the acceptability of ginkgolide plus aspirin was higher than that of placebo plus aspirin. The present cost-effectiveness analysis showed that addition of ginkgolides to conventional treatment is cost-effective at a threshold the Chinese per capita GDP.
