Cost-effectiveness analysis of commercial Chinese polyherbal preparations for primary insomnia: based on network meta-analysis

Objectives Building upon prior systematic reviews and network meta-analyses, this study evaluated the cost-effectiveness of four commercial Chinese polyherbal preparations (CCPPs)—Tian Meng Oral Liquid/Capsules (TM), Shen-Qi-Wu-Wei-Zi Tablets (SQWWZ), Wu Ling Capsules (WL), and Bai-Le-Mian Capsules (BLM)—for treating primary insomnia. Comparative findings informed clinical decision-making and health policy formulation. Methods A cost-effectiveness analysis was conducted from a healthcare system perspective. A patient disease course model was developed using systematic literature search and network meta-analysis combined with drug pricing data. Intervention strategies (monotherapy or combination therapy) were simulated to assess per-capita costs and health outcomes. Incremental cost-effectiveness ratios were calculated and compared against the willingness-to-pay threshold. Deterministic sensitivity analysis (DSA), Monte Carlo simulations for probabilistic sensitivity analysis and cost-effectiveness acceptability curves were used to test the overall stability and acceptable probability of the evaluation results. Results At a WTP threshold of ¥89,358.00 per quality-adjusted life year (QALY), the combination of TM and benzodiazepines (BZDs) ranked highest in terms of cost-effectiveness, followed by WL, BLM, and SQWWZ. When the WTP threshold exceeded ¥5,897.63 per QALY, the probability that TM + BZDs was more cost-effective than WL increased. Likewise, when the WTP threshold was above ¥19,658.76 per QALY, the probability that BLM was more cost-effective than SQWWZ became greater. Conclusion Within the 60-day time horizon of this analysis, TM + BZDs demonstrated optimal cost-effectiveness for primary insomnia from a healthcare system perspective, followed by WL and BLM. Limitations in data sources constrain the generalizability of findings. Future studies adopt a societal perspective and incorporate individual-level data over longer time horizons to validate and extend current results through more comprehensive cost-utility evaluations. Furthermore, research should focus on Traditional Chinese medicine (TCM)-specific health utility scales and informing equity-focused reimbursement policies to fully capture the value of CCPPs, thereby ultimately optimizing healthcare access and resource allocation.