Background

In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes.

Aims

This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data.

Methods

A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs.

Results

Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 – 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit.

Conclusions

Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors.

中文翻译：

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探索莫达非尼治疗澳大利亚中风后疲劳的经济效益：成本-效果评估

背景

在中风幸存者中，中风后疲劳预示着对日常生活的依赖以及无法重返工作岗位。莫达非尼有望作为减轻中风后疲劳和相关后遗症（例如功能和临床预后较差）的药物疗法。

目的

这项研究通过确定莫达非尼的增量成本效益比（ICER）并通过对全国范围内的潜在成本节约进行模拟，探索了莫达非尼在澳大利亚背景下治疗卒中后疲劳的成本效益。 MIDAS试用数据。

方法

进行了事后成本效益分析。A部分：患者水平的成本和健康影响数据（多维疲劳清单（MFI）分数）来自MIDAS试验和从卫生系统角度进行的分析。B部分：二次分析从国家生产力成本的角度模拟了莫达非尼治疗对社会的影响。

结果

A部分：对于MFI总疲劳评分的临床上最小的重要变化（10分），莫达非尼治疗的平均成本为3.60澳元/天/患者，即每名患者疲劳评分的单位为0.36澳元/天/天。对于基本情况，使用莫达非尼（与安慰剂相比）的ICER为131.73澳元（分别为最小和最大成本，为90.17 – 248.15美元）。B部分：由于在澳大利亚劳动年龄中风幸存者中广泛使用莫达非尼治疗，在一年内为社会节省的潜在生产力成本经计算为近4.67亿澳元，在10年内高达383,471,991,248澳元。巨大的社会效益。

结论

莫达非尼是一种治疗卒中后疲劳的极具成本效益的疗法，在澳大利亚劳动年龄的中风幸存者中广泛使用莫达非尼治疗，可显着提高生产力，并为社会带来潜在的成本节省。