OBJECTIVES: 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 the chemical drugs, Chinese guidelines for diagnosis and treatment of acute ischemic stroke recommends the application of Chinese patent medicines. Ginkgolide injection is commonly used in the clinical treatment of stroke in China for its effect in promoting blood circulation and removing blood stasis, clearing channels and activating collaterals. A GISAA RCT study evaluated the efficacy and safety between Ginkgolide plus Aspirin and Placebo plus Aspirin. This study intends to evaluate the long-term cost-effectiveness of Ginkgolide plus Aspirin compared with placebo plus Aspirin based on the RCT results and literature.

METHODS: A Markov model is constructed consisting 4 states: No significant disability, Disability, Stroke recurrence and Death. Therapeutic data is from GISAA study. Utilities, transition probabilities are extracted from literatures. Costs data is from China Health Statistics Yearbook and hospital record survey. Expected costs and QALYs of 13 years’ circles (Calculated by average age of subjects and Chinese life expectancy) are calculated through TreeagePro11 software. The WTP threshold is the Chinese per capita GDP in 2018, ￥64644/QALY. The results are analyzed by single factor and probability sensitivity analysis.

RESULTS: Ginkgolide plus Aspirin is found to have higher expected per-patient cost than placebo plus Aspirin, but also higher QALYs. Compared to placebo plus Aspirin, Ginkgolide plus Aspirin produces an incremental cost effectiveness ratio of ￥14920.17/QALY, which is below the WTP threshold. Probabilistic sensitivity analysis suggests that the acceptability of Ginkgolide plus Aspirin is higher than that of placebo plus Aspirin.

CONCLUSIONS: The cost-effectiveness analysis based on RCT shows that the addition of ginkgolides to conventional treatment is cost-effective at the threshold of Chinese per capita GDP.