COST-UTILITY ANALYSIS OF REMOTE ISCHEMIC CONDITIONING FOR ACUTE MODERATE ISCHEMIC STROKE BASED ON THE RICAMIS TRIAL
Author(s)
Chunlu Wang, Doctor Candidate.
Center for Health Insurance & Health Services Research, University of International Business and Economics, Beijing, China.
Center for Health Insurance & Health Services Research, University of International Business and Economics, Beijing, China.
OBJECTIVES: Remote ischemic conditioning (RIC) is a potential neuroprotective strategy for acute ischemic stroke (AIS). The RICAMIS trial reported that RIC plus routine care improved 90-day outcome (modified Rankin Scale [mRS] 0-1: 67.4% vs. 62.0%) among AIS patients.
METHODS: A cost-utility analysis was conducted from the Chinese healthcare system perspective. A hybrid model combined a 90-day decision-tree with a lifetime Markov model (mRS 0-5 alive states, a recurrent stroke hub state, and an absorbing death state). 90-day clinical inputs were taken from the RICAMIS full analysis set. The Markov model used 3-month cycles and a 5% discount rate. State-specific annual recurrence risks were calibrated using Chinese cohort data. After recurrent stroke, survivors were redistributed within 3 months to the same or worse mRS states, with 21% recurrence-related mortality. Health utilities were assigned using the VISTA China EQ-5D value set by mRS level. RIC intervention costs included depreciation of the device (6,000 CNY per unit), cuff consumables, and nursing time. The willingness-to-pay threshold was set at one times per capita gross domestic product in 2025 (99,665 CNY per quality-adjusted life year [QALY]).
RESULTS: In the base-case analysis, discounted lifetime total costs were 131,652 CNY for RIC plus usual care and 132,253 CNY for usual care alone. Total QALYs were 6.311 and 6.100, respectively, yielding an incremental cost of −601 CNY, an incremental QALY gain of 0.211, indicating strict dominance (lower cost and greater QALYs). In a sensitivity analysis without post-90-day functional transitions, the ICER was −4,332 CNY per QALY. Probabilistic sensitivity analysis showed a 100% probability that RIC was cost-effective at the 99,665 CNY per QALY threshold.
CONCLUSIONS: Under RICAMIS efficacy estimates and current Chinese cost inputs, RIC appears highly cost-effective for AIS, with dominance in the base case and key Markov extrapolation scenarios. Findings remain sensitive to RIC implementation costs and long-term extrapolation assumptions.
METHODS: A cost-utility analysis was conducted from the Chinese healthcare system perspective. A hybrid model combined a 90-day decision-tree with a lifetime Markov model (mRS 0-5 alive states, a recurrent stroke hub state, and an absorbing death state). 90-day clinical inputs were taken from the RICAMIS full analysis set. The Markov model used 3-month cycles and a 5% discount rate. State-specific annual recurrence risks were calibrated using Chinese cohort data. After recurrent stroke, survivors were redistributed within 3 months to the same or worse mRS states, with 21% recurrence-related mortality. Health utilities were assigned using the VISTA China EQ-5D value set by mRS level. RIC intervention costs included depreciation of the device (6,000 CNY per unit), cuff consumables, and nursing time. The willingness-to-pay threshold was set at one times per capita gross domestic product in 2025 (99,665 CNY per quality-adjusted life year [QALY]).
RESULTS: In the base-case analysis, discounted lifetime total costs were 131,652 CNY for RIC plus usual care and 132,253 CNY for usual care alone. Total QALYs were 6.311 and 6.100, respectively, yielding an incremental cost of −601 CNY, an incremental QALY gain of 0.211, indicating strict dominance (lower cost and greater QALYs). In a sensitivity analysis without post-90-day functional transitions, the ICER was −4,332 CNY per QALY. Probabilistic sensitivity analysis showed a 100% probability that RIC was cost-effective at the 99,665 CNY per QALY threshold.
CONCLUSIONS: Under RICAMIS efficacy estimates and current Chinese cost inputs, RIC appears highly cost-effective for AIS, with dominance in the base case and key Markov extrapolation scenarios. Findings remain sensitive to RIC implementation costs and long-term extrapolation assumptions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PT39
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)