Pharmacoeconomic evaluation of neuroprotective therapy of patients with acute ischemic stroke in Ukraine

Abstract

OBJECTIVES: Two approaches recanalization or restoration of adequate perfusion and neuroprotection are identified as a pathogenic treatment of acute ischemic stroke (AIS). Timely mechanical revascularization and thrombolytic therapy prevent the development of neurons necrosis and significantly improve survival and quality of patient life. Unfortunately, in Ukraine these methods are difficult of access for patients due to high cost, late diagnostics and contraindications. The feasibility of combined neuroprotection in patients with AIS convincingly are substantiated by leading Ukrainian neurologists. The aim is to evaluate the economic feasibility of combined regimens of neuroprotection compared with the traditional. METHODS: Analysis of the results of comparative clinical trial of three neuroprotective regimens therapy of patients with moderate and severe AIS: traditional citicoline (1 regimen); traditional citicoline actovegin (2 regimen); 3 regimen: traditional (pentoxifylline, heparin, acetylsalicylic acid, mannitol) (S. M. Vinychuk, O. A. Pustova, V.O. Mokchnach et al., 2008) was carried out. Cost-effectiveness analysis was used. Using a decision tree comparing the economic burden of the three regimens for one year was carried out. RESULTS: The number of patients who recovered completely after three months were used as efficacy. The efficacy for 1, 2 and 3 regimens were respectively 29.6%, 38.9% and 23.3%. Direct costs of the treatment regimens were $ 1.015; $ 1.186; $ 617 for 1, 2 and 3 regimens, respectively. Incremental cost-effectiveness ratio (ICER) for 1 and 2 regimens were respectively $6.317, $3.647. The economic burden per one patient for one year were $ 7006; $ 6511; and $ 6930 for 1, 2 and 3 regimens, respectively. CONCLUSIONS: The use of regimen 1 and regimen 2 provides greater efficacy and needs greater cost. With the forecast for one year and taking into account the indirect costs the neuroprotective regimen with combination of two drugs (regimen 2) has economic advantages.