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. Trial registration number [NCT03354429][1]. Data are available on reasonable request. For data requests, please contact the corresponding author. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03354429&atom=%2Fbmjno%2F5%2F2%2Fe000478.atom

中文翻译：

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替格瑞洛加阿司匹林与阿司匹林治疗急性缺血性卒中或短暂性脑缺血发作的成本效益：泰利斯试验的经济评估

目的 泰雷兹 (THALES) 证明，在轻中度急性非心源性缺血性卒中 (AIS) 或高危短暂性脑缺血发作 (TIA) 后 30 天内，替格瑞洛联合阿司匹林可降低卒中或死亡风险，但与阿司匹林相比会增加出血量。在欧洲，没有成本效益分析支持这种组合。为了解决这个问题，进行了成本效益分析。方法 使用决策树和马尔可夫模型在短期和长期（30 年）范围内评估成本效益。中风、死亡率、出血和 THALES 的 EuroQol-5 Dimension (EQ-5D) 数据用于估计短期结果。模型转换基于中风严重程度（失能中风定义为改良Rankin量表>2）。超过 30 天的医疗资源利用率和 EQ-5D 数据基于 SOCRATES，这是另一项 AIS/TIA 试验，将替格瑞洛与阿司匹林进行比较。长期成本、生存率和效用基于已发表的文献。单位成本来自国家数据库，从瑞典医疗保健的角度来看，每年折扣 3%。结果 从瑞典医疗保健的角度来看，替格瑞洛联合阿司匹林治疗一个月可减少 12 例中风、增加 4 例大出血，并且与阿司匹林相比，每 1000 名患者可节省 95,000 欧元的成本。这转化为每个患者一生中质量调整生命年的增加（0.04）和社会成本的降低（−1358 欧元）。成本效益的关键驱动因素是随后发生致残性中风的患者数量和残疾程度。研究结果在一系列输入假设下都是稳健的。结论 对于轻中度 AIS 或高危 TIA，替格瑞洛加阿司匹林治疗 1 个月可能会比阿司匹林改善预后并降低费用。试用注册号[NCT03354429][1]。可根据合理要求提供数据。如需数据请求，请联系相应作者。[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03354429&atom=%2Fbmjno%2F5%2F2%2Fe000478.atom