2026-04-17T22:56:15Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/102762025-10-24T10:33:29Zcom_2072_378070com_2072_378040col_2072_378092

2025-10-24T10:33:29Z urn:hdl:11351/10276 Cost-effectiveness of ticagrelor plus aspirin versus aspirin in acute ischaemic stroke or transient ischaemic attack: an economic evaluation of the THALES trial Tank, Amarjeet Johnston, S Claiborne Jain, Ritika Amarenco, Pierre Mellström, Carl Rikner, Klas Molina Cateriano, Carlos Malalties cerebrovasculars - Tractament Cost-eficàcia PUBLIC HEALTH::Epidemiology and Biostatistics::Epidemiology::Uses of Epidemiology::Cost-Effectiveness Evaluation DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke Other subheadings::Other subheadings::Other subheadings::/drug therapy SALUD PÚBLICA::epidemiología y bioestadística::epidemiología::usos de la epidemiología::evaluación de coste-efectividad ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia Health economics; Stroke Economía de la salud; Ictus Economia de la salut; Ictus Objective THALES demonstrated that ticagrelor plus aspirin reduced the risk of stroke or death but increased bleeding versus aspirin during the 30 days following a mild-to-moderate acute non-cardioembolic ischaemic stroke (AIS) or high-risk transient ischaemic attack (TIA). There are no cost-effectiveness analyses supporting this combination in Europe. To address this, a cost-effectiveness analysis was performed. Methods Cost-effectiveness was evaluated using a decision tree and Markov model with a short-term and long-term (30-year) horizon. Stroke, mortality, bleeding and EuroQol-5 Dimension (EQ-5D) data from THALES were used to estimate short-term outcomes. Model transitions were based on stroke severity (disabling stroke was defined as modified Rankin Scale >2). Healthcare resource utilisation and EQ-5D data beyond 30 days were based on SOCRATES, another trial in AIS/TIA that compared ticagrelor with aspirin. Long-term costs, survival and disutilities were based on published literature. Unit costs were derived from national databases and discounted at 3% annually from a Swedish healthcare perspective. Results One-month treatment with ticagrelor plus aspirin resulted in 12 fewer strokes, 4 additional major bleeds and cost savings of €95 000 per 1000 patients versus aspirin from a Swedish healthcare perspective. This translated into increased quality-adjusted life-years (0.04) and reduced societal costs (−€1358) per patient over a lifetime horizon. Key drivers of cost-effectiveness were number of patients experiencing subsequent disabling stroke and degree of disability. Findings were robust over a range of input assumptions. Conclusion One month of treatment with ticagrelor plus aspirin is likely to improve outcomes and reduce costs versus aspirin in mild-to-moderate AIS or high-risk TIA. AstraZeneca funded the THALES trial and the cost-effectiveness analysis of this study. 2025-10-24T10:33:29Z 2025-10-24T10:33:29Z 2023-09-13T12:40:02Z 2023-09-13T12:40:02Z 2023-08-24 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/10276 BMJ Neurology Open;5(2) http://dx.doi.org/10.1136/bmjno-2023-000478 Attribution-NonCommercial 4.0 International http://creativecommons.org/licenses/by-nc/4.0/ info:eu-repo/semantics/openAccess BMJ Scientia