Pharmacoeconomic Evaluation of Danhong Injection for Ischemic Stroke Patients: Real-World Evidence from China

OBJECTIVES: Ischemic stroke patients face a substantial disease burden and require more cost-effective treatment. However, previous economic evaluations of medications for ischemic stroke treatment are predominantly limited to chemical regimes, lacking real-world evidence on the cost-effectiveness of traditional Chinese medicine. Danhong Injection is a commonly used traditional Chinese medicine injection in the clinical treatment of stroke. The real-world evidence of Danhong Injection will provide references for the rational clinical medication use in stroke patients.

METHODS: We conducted a multicenter, prospective, observational study to investigate the effectiveness and economics of Danhong Injection in ischemic stroke patients from the perspective of the Chinese healthcare system. Eligible patients were categorized into two groups: the exposure group, receiving Danhong Injection plus standard treatment, and the non-exposure group, receiving standard treatment alone. We collected demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, EQ-5D-5L scale scores, and medical expenses during one-month follow-up.

Propensity score matching (PSM) was employed to control for confounding factors. Incremental Cost-Utility Ratios (ICUR) were used to assess the cost-utility of of the treatments. Additionally, subgroup analyses were conducted based on age, gender, baseline health status, and other criteria. Probability sensitivity analyses were performed considering patients' utility, probability values, and costs to validate the robustness of results.

RESULTS: The analysis included 1491 patients, and after 1:3 PSM, the sample size was 1420 cases (1131 exposure, 289 non-exposure). Results demonstrated better health outcomes in the exposure group than those of non-exposure group: lower NIHSS scores (1.16 vs. 1.86, p=0.00) and higher QALYs (0.067 vs. 0.058, p=0.00). Direct medical costs were slightly higher ($2100 vs. $1940, p=0.17), resulting in an ICUR of $18,700/QALY. Subgroup and sensitivity analysis results confirmed robustness.

CONCLUSIONS: At a threshold of twice the per capita GDP ($26800), the Danhong injection plus standard treatment group demonstrates cost-effectiveness compared to the standard treatment group alone.