Cilostazol, ticagrelor more cost-effective than standard therapy for acute ischaemic stroke

Use of CYP2C19 genotype-guided antiplatelet therapy with cilostazol or ticagrelor as a substitute to clopidogrel is more cost-effective than conventional antiplatelet therapy for patients with acute minor ischaemic stroke and high-risk transient ischaemic attack, suggests a China study.

Researchers used a 90-day decision tree and 30-year Markov model to assess the costs and quality-adjusted life years (QALYs) of personalized antiplatelet therapy for patients with minor ischaemic stroke and high-risk transient ischaemic attack compared with standard treatment in the Chinese healthcare system. Incremental cost-effective ratio (ICER) was the primary endpoint.

Data were obtained from clinical trials, published literature, official documents, and local prices. The research team conducted one-way sensitivity analysis and probabilistic sensitivity analysis to confirm the robustness of the findings.

On base-case analysis, the CYP2C19 genotype-guided antiplatelet strategy demonstrated cost-effectiveness: the cilostazol and ticagrelor groups had respective ICER of USD 3,327.40/QALY and USD 3,426.92/QALY, both of which were less than the threshold.

One-way sensitivity analysis confirmed the robustness of the results, in which the most sensitive parameters was the disability distribution in the modified Rankin scale 3‒4. On probabilistic analysis, the CYP2C19 genotype-guided antiplatelet therapy with either cilostazol or ticagrelor showed 100-percent cost-effectiveness under the willingness-to-pay threshold.