Cost effectiveness of testing for CYP2C19 loss-of-function carriers following transient ischemic attack/minor stroke: A Canadian perspective

 COST! Wrong focus. You measure recovery and results, measuring cost does nothing to get survivors recovered. 

“What's measured, improves.” So said management legend and author Peter F. Drucker 

Cost effectiveness of testing for CYP2C19 loss-of-function carriers following transient ischemic attack/minor stroke: A Canadian perspective

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Andrew Micieli, Nishita Singh, Beate Jahn, ...

First Published June 23, 2022 Research Article 

https://doi.org/10.1177/17474930221111898

Article information

Abstract

Background— 

The CHANCE-2 study compared three weeks of aspirin-ticagrelor to aspirin-clopidogrel in CYP2C19 loss-of-function (LOF) allele carriers following a TIA/minor stroke and demonstrated a modestly lower risk of stroke recurrence with aspirin-ticagrelor. This stroke protection was largely for minor stroke and came at an increased risk of bleeding. The cost effectiveness of implementing testing for LOF allele status to personalize antiplatelet regimen for secondary stroke prevention after a TIA/minor stroke in the Canadian health care context is unknown.

Methods— 

Cost effectiveness analysis using a decision-analytic Markov cohort model with a lifetime horizon was performed to determine the costs and health benefits of testing for LOF allele status compared with no testing (current standard of care). The population of interest was patients living in Canada who suffered a TIA/minor stroke. Outcomes of interest were life-years gained (LYG), quality-adjusted life years (QALY) gained, costs (reported in 2022 Canadian dollars) and the incremental cost-effectiveness ratio (ICER). We adopted the perspective of the Federal, Provincial and Territorial Ministries of Health, and used a 1.5% annual discount rate. Sensitivity analyses were performed to assess uncertainty.

Results—  

Compared to standard of care, LOF allele testing leads to 0.14 LYG (undiscounted), 0.12 QALYs gained (undiscounted) and additional lifetime costs of $432 (discounted) per patient. The ICER of the LOF allele testing strategy is $4310 per QALY gained compared with standard of care. The probabilistic sensitivity analyses demonstrated that LOF allele testing was cost-effective in more than 99.99% of simulations using a willingness-to-pay threshold of $50,000 per QALY.

Conclusions— 

Based on available evidence, testing for LOF allele followed by short duration three weeks of aspirin-ticagrelor compared to standard of care aspirin-clopidogrel can lead to prolonged life and improved quality of life, and can be considered very cost effective when compared with other well-accepted technologies in health and medicine.

Keywords

Aspirin, Antiplatelet therapy, Cost factors, Economics, Ischaemic stroke, Stroke

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