A comparative clinical and economic advisability of neuroprotective therapy with ethylmethylhydroxypyridine succinate and Cerebrolysin in patients with ischaemic stroke

The high cost of managing stroke patients is due not only to the care provided during the most acute and acute phases, but also to the subsequent costs associated with rehabilitation and potential disability. Achieving a favourable functional outcome is one of the key factors in reducing the economic burden of stroke on the healthcare system.

Objective: to assess the clinical and economic advisability of incorporating ethylmethylhydroxypyridine succinate (Mexidol) or Cerebrolysin into the treatment of ischaemic stroke (IS) during the acute and early recovery phases, compared with standard treatment.

Material and methods. Randomized, placebo-controlled trials of Mexidol and Cerebrolysin were included in the model. Efficacy measures for the pharmacoeconomic calculations were derived by conditionally pooling the trial results within the adopted model. Pharmacoeconomic methods such as cost-effectiveness analysis (cost-effectiveness analysis, CEA) with the calculation CER=DC/Ef, budget impact analysis (BIA), a single-factor sensitivity analysis (a 15% increase in the price of Mexidol), and the calculation of the incremental cost-effectiveness ratio (ICER). The cost of drug therapy was determined using the register of maximum retail prices for essential and vital medicines, whilst the costs of treatment/rehabilitation and the consequences of disability were based on Russian data on the socio-economic burden of stroke.

Results. The modelling results show that incorporating Mexidol into IS therapy would result in savings of 19.96 per cent of the budget over one year and 27.63 per cent over four years, respectively. According to the cost-effectiveness analysis, the CER for Mexidol was 80,647,447 roubles for a 10-day course and 81,922,447 roubles for a full course. These figures are lower than those for standard therapy (121,608,837 roubles) and lower than those in the one-year model for Cerebrolysin (122,317,082 roubles for the main course and 128,917,082 roubles for the supplementary course).

Conclusion. Under the adopted model, the inclusion of Mexidol in standard IS treatment is associated with a reduction in direct costs and a more favourable cost-effectiveness ratio compared with the addition of Cerebrolysin to standard treatment.

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