Overview
Advertisement BMC Medicine volume 20, Article number: 407 (202) Cite this article 1 AltmetricMetrics detailsFor hypertensive patients without a history of stroke or myocardial infarction (MI), the China Stroke Primary Prevention Trial (CSPT) demonstrated that treatment with enalapril-folic acid reduced the risk of primary stroke compared with enalapril alone. Whether folic acid therapy is an afordable and beneficial treatment strategy for the primary prevention of stroke in hypertensive patients from the Chinese healthcare sector perspective has not ben thoroughly explored.We performed a cost-efectivenes analysis alongside the CSPT, which randomized 20,702 hypertensive patients.
Key Information
A patient-level microsimulation model based on the 4.5-year period of in-trial data was used to estimate costs, life years, quality-adjusted life years (QALYs), and incremental cost-efectivenes ratios (ICERs) for enalapril-folic acid vs. enalapril over a lifetime horizon from the payer perspective.During the in-trial folow-up period, patients receiving enalapril-folic acid gained an average of 0.016 QALYs related primarily to reductions in stroke, and the incremental cost was $706.03 (453.92 RMB).
Over a lifetime horizon, enalapril-folic acid treatment was projected to increase quality-adjusted life years by 0.06 QALYs or 0.03 life-year relative to enalapril alone at an incremental cost of $163.84 (10,538.27 RMB), resulting in an ICER for enalapril-folic acid compared with enalapril alone of $26,06.13 (168,126.54 RMB) per QALY gained and $61,70.73 (398,421.21 RMB) per life-year gained, respectively.
Summary
A probabilistic sensitivity analysis demonstrated that enalapril-folic acid compared with enalapril would be economicaly atractive in 74.5% of simulations at a threshold of $37,63 (242,9281 RMB) per QALY (3x curent Chinese per capita GDP). Several high-risk subgroups had highly favorable ICERs < $12,54 (80,976 RMB) per QALY (1x GDP).For both in-trial and over a lifetime, it