OBJECTIVES : In China, both human urinary kallindinogenase (HUK) and 3-n-butylphthalide (NBP) were recommended for clinical use to improve cerebral blood circulation during an acute ischemic stroke (AIS). The objective of this study was to evaluate the economic value of HUK versus NBP for patients with AIS.

METHODS : An economic evaluation based on data of patients who have been treated with either HUK (N=885) or NBP (N=488) from a prospective, phase IV, multicentre, clinical registry study (Chinese Acute Ischemic Stroke Treatment Outcome Registry, CASTOR) was conducted to analyse the cost and effectiveness of HUK versus NBP for AIS in China. Before the analysis, the patients were matched using propensity score. Both a cost-minimisation analysis and a cost-effectiveness analysis were conducted to compare the matched pairs. A bootstrapping exercise was also conducted for the matched arms to demonstrate the probability of one intervention being cost-effective over another for a given willingness-to-pay for an extra quality-adjusted life-year (QALY).

RESULTS : After propensity score matching, indicating HUK is preferred with cost-minimisation analysis. Although the QALY gained in NBP arm (0.69170) compared with it in HUK arm (0.68223) is statistically insignificant (p=0.4632), we conducted a cost-effectiveness analysis as exploratory analysis to learn that NBP is not cost-effective compared with HUK under a 3-time-GDP threshold, with the incremental cost and QALY of NBP over HUK are CNY 4457.13 and 0.00947, respectively. Among the 5000 bootstrapping replications, 98.96% indicates that NBP is not cost-effective compared with HUK under a 1-time-GDP threshold; and 60.30% indicates the same under a 3-time-GDP threshold.

CONCLUSIONS : This economic evaluation study indicates that administrating HUK is a cost saving therapy compared with NBP for managing blood flow during AIS in Chinese setting with similar clinical effectiveness.