Pharmacoeconomic analysis of neuroprotectors used in the treatment of ischemic stroke

Authors:
R.I. YAGUDINA¹, A.Yu. KULIKOV¹, V.A. KRYLOV¹, E.Yu. SOLOVYEVA², A.I. FEDIN²

¹Federal State Budgetary Institution of Higher Education “I.M. Sechenov First Moscow State Medical University” of the Russian Ministry of Health (Sechenov University), Moscow, Russia;
²Federal State Budgetary Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Russian Ministry of Health, Moscow, Russia

Place of publication:
S.S. KORSAKOV JOURNAL OF NEUROLOGY AND PSYCHIATRY, 2019, Vol. 119, No. 7

Abstract:
Objective of the study. To conduct a pharmacoeconomic analysis of the most frequently prescribed neuroprotective drugs for the treatment of patients with mild ischemic stroke (IS) in the acute and early recovery periods in the Russian Federation. Material and methods. Three medical technologies were compared: ethylmethylhydroxypyridine succinate (Mexidol), inosine + nicotinamide + riboflavin + succinic acid (Cytoflavin), and deproteinized hemoderivative of calf blood (Actovegin). Based on the results of the indirect comparison, a pharmacoeconomic analysis was conducted using the following methods: cost minimization analysis, budget impact analysis, and sensitivity analysis. Results. An efficiency analysis showed that the studied drugs have equal efficiency: the difference in the means for Actovegin was 0.2 (CI min 0.18; max 0.22), for Mexidol it was 0.2 (confidence interval - CI - min 0.25; max 0.65), for Cytoflavin it was 0.61 (CI min 0.23; max 0.99). A cost minimization analysis showed that the cost of a course of therapy for one patient with Mexidol is accompanied by the lowest costs, and the savings are observed when assessing both the total costs and individual components: injection solution and tablet forms. The savings compared to Cytoflavin and Actovegin amount to 231 rubles and 12,872 rubles, respectively. The funds saved from just one course of treatment could be used to additionally treat 5 patients with ischemic stroke with Mexidol. Moreover, oral therapy with Mexidol is 164 rubles cheaper than therapy with similar dosage forms of Cytoflavin and Actovegin, which is an advantage for the population during outpatient treatment. A budget impact analysis showed that total costs with the current distribution of patients among treatment regimens amount to 1.99 billion rubles. A 10% increase in the proportion of patients receiving Mexidol would result in total costs of 1.75 billion rubles, which is 240 million rubles less than the current level. These savings could be used to treat an additional 85,000 patients with ischemic stroke. A two-way sensitivity analysis showed that the cost minimization and budget impact analysis remains stable with changes in the number of patients and the price of 1 mg of Mexidol ranging from -10% to +10%. Conclusion. An indirect comparison revealed that Mexidol, Cytoflavin, and Actovegin are equally effective. However, Mexidol has an advantage in terms of cost-minimization analysis: the savings from one course of treatment with alternatives are sufficient to treat five patients with ischemic stroke. An analysis of the effects of increasing the proportion of patients receiving Mexidol also revealed cost savings, suggesting that Mexidol therapy is cost-effective for the treatment of mild ischemic stroke in the Russian Federation. Keywords: pharmacoeconomics, indirect comparison, cost-minimization analysis, budget impact analysis, neuroprotectors, ischemic stroke.