Comparative Analysis of Safety, Effectiveness, and Cost-Effectiveness of Traditional Chinese Medicine Injections in the Treatment of Ischemic Stroke: A Network Meta-Analysis
Authors: Xing Wang, Gang Chen, ...
Background: Ischemic stroke is a leading cause of disability and mortality worldwide. Traditional Chinese Medicine (TCM) injections are widely used in China as adjunctive therapy, but comparative evidence is lacking. This network meta-analysis aimed to evaluate the safety, effectiveness, and cost-effectiveness of different TCM injections for ischemic stroke. Methods: We systematically searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases up to October 2024. Randomized controlled trials (RCTs) comparing TCM injections (e.g., Xingnaojing, Shenmai, Danhong, etc.) with conventional treatment or placebo were included. A Bayesian network meta-analysis was performed to compare outcomes including neurological function improvement (NIHSS score), adverse events, and cost-effectiveness. Results: A total of 45 RCTs involving 4,320 patients were included. Xingnaojing injection showed the highest probability of improving neurological function (SUCRA=0.85), followed by Danhong (0.78) and Shenmai (0.72). All TCM injections had similar safety profiles, with no significant differences in adverse events. Cost-effectiveness analysis indicated that Xingnaojing was the most cost-effective option in the Chinese healthcare setting. Conclusion: TCM injections, particularly Xingnaojing, may offer additional benefits in neurological recovery without increasing adverse events, and are cost-effective in China. However, due to heterogeneity and potential publication bias, further high-quality trials are warranted.
