Economic Evaluation Of Urinary Kallidinogenase Combined With Fibrinogenase In The Treatment Of Acute Ischemic Stroke

Objective: To evaluate the safety,efficiency and economy of urinary kallidinogenase combined with fibrinogenase in the treatment of acute ischemic stroke,and to provide reference for clinical rational use of drugs.Methods: 186 cases of acute ischemic stroke inpatients who met the inclusion criteria were studied prospectively,non-interventionally and continuously.According to the actual treatment,patients were divided into three groups: routine treatment group(the routine group,n=38),the group of routine therapy combined with urinary kallidinogenase(urinary kallidinogenase group,n=81)and routine treatment plus Urinary Kallidinogenase combine with fibrinogenase(the combination group,n=67).All recordings were made after the onset of hospitalization for first day,the NIHSS scores of fourteenth days,90 d m RS scores,the EQ-5D scale index scores of admission and 90 days after the onset,cost of hospitalization,recurrence,motality and drug related adverse reactions.Decision tree model and Markov model are used to evaluate the cost-effectiveness analysis and cost-utility analysis of the three treatment options.Result: There was no significant difference in baseline data among the three groups(p>0.05).The overall response rate after 14-day treatment was compared.The overall response rate of the combined group and the urinary kallidinogenase group was higher than the routine group(79.1%,75.3% and 57.89%,respectively),and the difference was statistically significant(P<0.05),but there was no statistically significant between the combined group and the urinary kallidinogenase group.The proportion of patients with favourable prognosis and the quality of life in 90 days after the onset were no significant difference among the three groups.There were 1 case,3 cases and 2 cases of symptomatic intracranial hemorrhage in the routine group,the urinary kallidinogenase group and the combined group,with the incidence of 2.63%,3.70% and 2.99%,respectively,with no significant difference(p>0.05).In the three groups,the cost of the routine group was the lowest,and so was the response rate.Compared with the routine group,the decision tree model showed that for each 1% increase in effectiveness ICER is 313.04 yuan,and the Markov model showed that the ICER for each additional QALY is 20298.16 yuan.Both of them was less than the GDP per capita of China,and the increase in cost was acceptable,The urinary kallidinogena group was economic.Compared with the routine group,the decision tree model shows that the ICER for each 1% increase in effectiveness was 308.13 yuan,and the Markov model showed that the ICER for each additional QALY is 18709.59 yuan in the combination group,both of them were less than the GDP per capita of China,and the added cost was worthy,and the ICER were lower than those in the fibrinogenase group,so the the combination group was more economical than the urinary kallidinogena group.The results of the sensitivity analysis also proved that the conclusion was stable and not affected by various factors.Conclusions: The three treatment options could significantly improve the neurological deficits,the prognosis and the quality of life and did not increase the incidence of symptomatic intracranial hemorrhage.Comparing with the routine group,the economic benefits of the short-term and long-termwas better in the urinary kallidinogenase group.Both the decision tree model and the Markov model all showed that the combined group was more cost-effective than the urinary kallidinogenase group.