Cost-effectiveness of citicoline versus conventional treatment in acute ischemic stroke

Abstract

In the framework of an integral assessment (effectiveness and cost) of the use of neuroprotection in stroke, a cost-effectiveness study was conducted to compare the potential advantages of citicoline with conventional therapy (without neuroprotection or placebo) in patients with acute ischemic stroke. The literature was searched for systematic reviews and meta-analyses evaluating the effectiveness of citicoline versus placebo in the hospital setting and during 12 weeks after discharge from hospital. Data on the use of resources were obtained from a panel of experts of four acute-care teaching hospitals in Spain. The study was performed from the perspective of the Spanish National Health System. Two meta-analyses were included (Cochrane Stroke Review Group and a pooling analysis). Treatment with citicoline resulted in 99 or 50 more patients recovered per 1000 patients treated (depending on selection criteria of the Cochrane study and the pooled analysis), with average cost savings between €101.2 and €126.4 per patient treated of the type of those included in the Cochrane study. In patients with acute ischemic stroke, treatment with placebo was more expensive and less effective in the scenarios of inpatient care and inpatient plus outpatient care after discharge from the hospital.

Keywords::

• brain ischemia
• citicoline
• cost-effectiveness
• cytidine diphosphate choline
• pharmacoeconomics
• stroke

Acknowledgements

The authors are grateful to the research teams of Hospital Universitari Josep Trueta (Girona, Spain), Hospital Clínico Universitario (Santiago de Compostela, Spain), Hospital Vall d’Hebron (Barcelona, Spain), and Hospital La Paz (Madrid, Spain) for their contribution to the study, and Marta Pulido for editing the manuscript and for editorial assistance.

Financial & competing interests disclosure

Alfonso Casado, Raquel Ibarz, Michael Herdman and Max Brosa received payment for this work from Ferrer Group. Julio Secades is a full-time employee of Ferrer Group. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance from Content Ed Net Communications was utilized in the production of this manuscript.