Cost-Effectiveness Analysis of Ginkgolide Injection in the Treatment of Ischemic Stroke Based on a Randomized Clinical Trial

Abstract

Objective: To evaluate the long-term cost-effectiveness of ginkgolide plus aspirin compared with placebo plus aspirin treatment of ischemic stroke. Background: 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 Western medicines, Chinese clinical guidelines for diagnosis and treatment of acute ischemic stroke recommend application of Chinese patent medicines. Ginkgolide injection is commonly used in the clinical treatment of stroke in China to promote blood circulation and remove blood stasis. The economy of ginkgolide injection needs to be evaluated. Methods: A Markov model was constructed consisting of four disease states: no significant disability, disability, stroke recurrence, and death. Therapeutic data were taken from the Ginkgolide in Ischemic Stroke Patients with Large Artery Atherosclerosis (GISAA) study. Utilities and transition probabilities were extracted from the literature. Cost data were obtained from the China Health Statistics Yearbook and hospital record survey. Expected costs and quality-adjusted life-years (QALYs) of 13 years of cycles (calculated by average age of subjects and Chinese life expectancy) were calculated through TreeAge Pro11 software. The willingness-to-pay (WTP) threshold was set as the Chinese per capita Gross Domestic Product (GDP) in 2019, CNU70,892/QALY. The results were analyzed by single factor and probability sensitivity analyses. Results: Ginkgolide plus aspirin had a higher expected per-patient cost than placebo plus aspirin but a higher QALYs. Compared with placebo plus aspirin, ginkgolide plus aspirin produced an incremental costeffectiveness ratio of CNU14,866.06/QALY, which is below the WTP threshold. Probabilistic sensitivity analysis suggested the acceptability of ginkgolide plus aspirin was higher than that of placebo plus aspirin. Conclusions: The present cost-effectiveness analysis showed that addition of ginkgolides to conventional treatment is cost-effective at a threshold the Chinese per capita GDP.

Cost-effectiveness of edaravone dexborneol versus edaravone for the treatment of acute ischemic stroke in China: Based on the TASTE study

“…The cost of intravenous injections was obtained from the mean price of medical services in 12 provinces across China to represent the national medical service price level (i.e., Beijing, Shanghai, Jiangsu, and Zhejiang). The costs of recurrent stroke were derived from the published literature ( Xiang et al, 2021 ). All costs were discounted at 5% annually and inflated in 2021 Chinese Yuan 2020 using the medical care component of the consumer price index ( Table 1 ).…”

The Efficacy and Safety of Ginkgo Terpene Lactone Preparations in the Treatment of Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

“…Ginkgo diterpene lactone meglumine injection is one of the monomer injections that have been approved for marketing, which includes effective ingredients of ginkgolides A, B, and K with advantages of high content of active ingredients and low adverse reactions ( Zhou et al, 2017 ). Additionally, previous studies have demonstrated that ginkgolide injection and ginkgolide B can protect against IS as well ( Nabavi et al, 2015 ; Xiang et al, 2021 ). In this meta-analysis, we further found that clinical efficacy of ginkgo terpene lactone injections (especially ginkgo diterpene lactone meglumine injection) was superior to that of other drugs in the treatment of IS including ginkgo leaf extract and dipyridamole injection and Shuxuening injection.…”

Selective ischemic-hemisphere targeting Ginkgolide B liposomes with improved solubility and therapeutic efficacy for cerebral ischemia-reperfusion injury

“…Besides, G. biloba diterpene lactone meglumine injection (referred to GB injection in this study), extracted from G. biloba containing over 50% GB and other diterpene lactones, was chosen as a positive control. The therapeutic effect of this injection plus aspirin has also been clinically validated for vascular recanalization and neuron recovery after stroke [14] .…”