Safflower Yellow Pigment and Sanqi in the Treatment of Acute Cerebral Infarction: a Systematic Review, Meta-analysis, and Cost-effectiveness Analysis

Background: Sanqi injection and safflower yellow injection were Chinese traditional medicine injections for the treatment of cardiovascular diseases and were used to treat acute cerebral infarction patients in public hospital widely. The aim of this study was to compare and analyze the published reports of efficacy and safety of Sanqi injection and safflower yellow injection for the treatment of acute cerebral infarction. The cost-effectiveness of these drug formulations was also evaluated.

Methods: China National Knowledge Infrastructure (CNKI), Wanfang, SinoMed, VIP, PubMed, Embase, and the Chinese Biomedical Literature (CBM) were searched with the restrictions keywords in Chinese and English between 2006 and 2019 to obtain RCTs. A meta-analysis and a meta-regression analysis were undertaken in Reviewer Manager 5.3 software to compare the efficacy and safety of Sanqi and safflower yellow injection. This study used a decision tree model to analyze the cost-effectiveness of the two treatments. The TreeAge Pro software was used to comprehensively evaluate the economics of these medications.

Results: Twelve papers were all randomized controlled trials (RCTs) in which Sanqi injection was applied in the control group, while safflower yellow injection was applied in the experimental group and the quality of them were good. The results of the 12 papers were compared, and the total effective rate of the treatment group (91.18%) was significant and showed no significant difference with the control group (74.83%) (RR =1.24, 95% CI: 1.19, 1.30, P<0.00001). From the perspective of pharmacoeconomics, compared with Sanqi group, the ICER of safflower yellow injection is 3,885.75 RMB. The sensitivity analysis results were consistent with the basic analysis results, indicating that the basic analysis results were relatively stable.

Conclusions: Comparing with Sanqi injection, safflower yellow injection and related combination therapy can improve the total effective rate and are safer with fewer adverse reactions. It is also more cost-effective than the use of Sanqi injection.