Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Apr 2024)

Cost‐Effectiveness of Increased Use of Dual Antiplatelet Therapy After High‐Risk Transient Ischemic Attack or Minor Stroke

  • Paul M. Wechsler,
  • Ankur Pandya,
  • Neal S. Parikh,
  • Junaid A. Razzak,
  • Halina White,
  • Babak B. Navi,
  • Hooman Kamel,
  • Ava L. Liberman

DOI
https://doi.org/10.1161/JAHA.123.032808
Journal volume & issue
Vol. 13, no. 7

Abstract

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Background Rates of dual antiplatelet therapy (DAPT) after high‐risk transient ischemic attack or minor ischemic stroke (TIAMIS) are suboptimal. We performed a cost‐effectiveness analysis to characterize the parameters of a quality improvement (QI) intervention designed to increase DAPT use after TIAMIS. Methods and Results We constructed a decision tree model that compared current national rates of DAPT use after TIAMIS with rates after implementing a theoretical QI intervention designed to increase appropriate DAPT use. The base case assumed that a QI intervention increased the rate of DAPT use to 65% from 45%. Costs (payer and societal) and outcomes (stroke, myocardial infarction, major bleed, or death) were modeled using a lifetime horizon. An incremental cost‐effectiveness ratio <$100 000 per quality‐adjusted life year was considered cost‐effective. Deterministic and probabilistic sensitivity analyses were performed. From the payer perspective, a QI intervention was associated with $9657 in lifetime cost savings and 0.18 more quality‐adjusted life years compared with current national treatment rates. A QI intervention was cost‐effective in 73% of probabilistic sensitivity analysis iterations. Results were similar from the societal perspective. The maximum acceptable, initial, 1‐time payer cost of a QI intervention was $28 032 per patient. A QI intervention that increased DAPT use to at least 51% was cost‐effective in the base case. Conclusions Increasing DAPT use after TIAMIS with a QI intervention is cost‐effective over a wide range of costs and proportion of patients with TIAMIS treated with DAPT after implementation of a QI intervention. Our results support the development of future interventions focused on increasing DAPT use after TIAMIS.

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