Efficacy, safety, and costs of nine Chinese patent medicines for the treatment of angina pectoris in CHD

Objective: This study employed a multidimensional evaluation framework (of efficacy, safety, and costs) to comprehensively assess the value of Chinese patent medicines (CPMs) combined with Western medicine in treating coronary heart disease (CHD) angina pectoris with Qi deficiency and blood stasis pattern. Methods: Efficacy analysis was based on a network meta-analysis (NMA) of 24 randomized controlled trials (RCTs). Safety was assessed using a standardized framework that graded adverse events via CTCAE v5.0 and synthesized risk profiles into a Composite Safety Score. A pragmatic Cost-Consequence Analysis (CCA) was employed to synthesize direct daily treatment costs with clinical efficacy rankings (SUCRA). Results: = 2,382) showed that CPMs combined with conventional medicine significantly improved clinical efficacy (OR 3.08, 95% CI: 2.46-3.85). Dengzhan Shengmai Capsule (SUCRA 88.99%) and Shexiang Tongxin Dropping Pill (SUCRA 75.12%) ranked highest in efficacy. Safety analysis using the Composite Safety Score (CSS) identified Yangxinshi Tablet as having the most favorable profile (CSS = 3), whereas Xintong Granule and Qishen Capsule presented higher risks (CSS = 9) due to hepatotoxicity concerns or data gaps. Cost-consequence analysis revealed distinct value profiles: Yangxinshi Tablet offered the lowest daily cost (CNY 6.24) suitable for cost-minimization; Shexiang Tongxin Dropping Pill (CNY 7.28) provided a balanced cost-efficacy ratio; while Dengzhan Shengmai Capsule (CNY 10.86) represented a premium high-efficacy option. Sensitivity analysis confirmed the robustness of efficacy findings but highlighted cost fluctuations in flexible-dose regimens. Conclusion: Specific CPMs, notably Dengzhan Shengmai Capsule (maximal efficacy), Shexiang Tongxin Dropping Pill (balanced value), and Yangxinshi Tablet (cost-minimization), demonstrate significant therapeutic and economic advantages as add-on therapies. Beyond these clinical findings, this study establishes a multidimensional framework aligned with international regulatory standards, serving as a model for the future pharmacoeconomic integration of TCM into global cardiovascular care.