Cost-effectiveness of Qiliqiangxin in HFrEF: adjunctive therapy vs. standard care from a Chinese healthcare perspective

BACKGROUND: China has the highest global burden of heart failure (HF), with heart failure with reduced ejection fraction (HFrEF) patients experiencing the greatest mortality risk. The QUEST trial demonstrated that Qiliqiangxin (QLQX) capsules could improve outcomes for Chinese HFrEF patients, but the cost-effectiveness of QLQX has not been previously evaluated. METHODS: We developed a lifetime Markov model to assess the cost-effectiveness of adding QLQX to standard therapy compared to standard therapy alone in a simulated cohort of 63-year-old HFrEF patients. The incremental cost-effectiveness ratio (ICER), defined as incremental cost per quality-adjusted life-year (QALY), was the primary outcome. A willingness-to-pay (WTP) threshold was set at three times China's per capita GDP. One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. RESULTS: Adding QLQX to standard treatment resulted in an additional 0.53 QALYs (4.74 vs. 4.22 QALYs) at an incremental cost of 28,760 Chinese Yuan (CNY) (USD 4,081), yielding an ICER of 54,522 CNY (USD 7,737) per QALY. This ICER was significantly below the WTP threshold. Sensitivity analyses confirmed the robustness of these findings. CONCLUSION: QLQX capsules, as adjunctive therapy to standard treatment, represent a cost-effective strategy for managing HFrEF in China, supporting their inclusion in clinical guidelines and reimbursement policies. Real-world studies are needed to validate these results further.