OMG, what stupidity. Research on cost rather than recovery! Do you really think survivors care about cost? Talk to them sometimes, they are your clients after all. The stupid, it burns.
Cost-effectiveness of testing for CYP2C19 loss-of-function carriers following transient ischemic attack/minor stroke: A Canadian perspective
Abstract
Background:
The
CHANCE-2 study compared 3 weeks of aspirin–ticagrelor to
aspirin–clopidogrel in CYP2C19 loss-of-function (LOF) allele carriers
following a transient ischemic attack (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 CAD$432 (discounted) per patient. The ICER of the LOF
allele testing strategy is CAD$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 CAD$50,000 per QALY.
Conclusion:
Based
on available evidence, testing for LOF allele followed by short
duration 3 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.
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