Pharmacoeconomic analysis of the use of combinations of complex electrolyte compounds with citicoline in the treatment of patients with acute ischemic stroke in Ukraine

Abstract

Ischemic stroke is a clinical syndrome of rapid development of signs of focal or global loss of brain function that lasts 24 hours or more or leads to death without other (nonvascular) causes. Cerebral stroke is one of the most severe forms of cerebrovascular disease.  A significant place in stroke pharmacotherapy is occupied by prescription drugs that increase the preservation of nervous tissue. Citicoline is an essential mediator in phosphatidylcholine biosynthesis, a major component of biological membranes. The study aimed to analyze the cost-effectiveness and budget impact on using of complex electrolyt compounds with citicoline combinations in treatment of patients with acute ischemic stroke in Ukraine. The cost analysis was based on a decision tree model developed for treatment within 28 days after an ischemic stroke, including the likelihood that a patient will need to undergo rehabilitation care in an out-patient or in-patient treatment. The cost of direct expenses was determined based on the results of the course of Neurocytin® in combination with standard therapy, compared to the use of standard therapy alone, which, according to the results of the modelled analysis, is 30 407.10 UAH and 28 171.43 UAH per 1 person, respectively. Due to performing a pharmacoeconomic analysis using the cost-effectiveness method, the cost-utility indicator was calculated, which for treatment with Neurocytin® is 47 142.79 UAH, and for standard therapy – 46 031.74 UAH. The calculated ICUR value is 68 996.36 UAH, which indicates that the technology of Neurocytin® in combination with standard therapy is more effective and more costly. The ratio of the potential threshold of «willingness to pay» and the ICUR value visually demonstrates that in terms of cost-effectiveness, the technology of Neurocytin® in combination with standard therapy is within the threshold of willingness to pay from the perspective of the state budget. Based on the budget impact analysis results, it was found that the cost of Scenario 3 (an annual 20% increase in the number of patients prescribed Neurocytin® in combination with standard therapy) will amount to 17.2 billion UAH.