{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:03:41Z","timestamp":1784117021410,"version":"3.55.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,11,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Pioglitazone significantly reduces the risk of stroke in people with diabetes, and in those with prediabetes, it markedly reduces the risk of stroke\/myocardial infarction and new\u2010onset diabetes. Low\u2010dose pioglitazone provides most of the clinical benefits of high\u2010dose pioglitazone, with fewer adverse effects. We report an economic evaluation of the cost\u2010effectiveness of low\u2010dose pioglitazone versus placebo from a Canadian public payer perspective in 2023 Canadian dollars.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">A Markov model was developed at a lifetime horizon with an annual cycle length and 5 health states (event\u2010free, myocardial infarction, stroke, new\u2010onset diabetes, and death). Transition probabilities were extracted from the IRIS (Insulin Resistance Intervention in Stroke) trial. Health state costs and utilities were based on public sources. Annual discount rates of 1.5% were applied in the reference\u2010case analysis. Probabilistic analyses were conducted to deal with parameter uncertainty through 5000 simulations. The costs were estimated as $24 887 (interquartile range [IQR], $14\u2009632\u2013$41507) for low\u2010dose pioglitazone and $57\u2009301 (IQR, $48\u2009730\u2013$67368) for placebo, resulting in a cost saving of \u2212$30\u2009287 (IQR, \u2212$43\u2009374 to \u2212$14\u2009587) in favor of low\u2010dose pioglitazone. Quality\u2010adjusted life years were estimated as 25.99 (IQR, 24.56\u201326.81) for the low\u2010dose pioglitazone and 19.44 (IQR, 18.68\u201320.13) for placebo, resulting in a difference of 6.37 (IQR, 5.07\u22127.36) in favor of low\u2010dose pioglitazone. Consistent findings were observed from scenario analyses and 1\u2010way probability sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Holding across a wide range of values in modeling parameters, low\u2010dose pioglitazone is found as the dominant strategy versus a placebo.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.034531","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T07:03:19Z","timestamp":1729839799000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Cost\u2010Utility Analysis of Low\u2010Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5408-8261","authenticated-orcid":false,"given":"Fei","family":"Yuan","sequence":"first","affiliation":[{"name":"Population Health Research Institute, DBCVSRI","place":["Hamilton, Canada"]},{"name":"McMaster University","place":["Hamilton, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7478-1098","authenticated-orcid":false,"given":"J. David","family":"Spence","sequence":"additional","affiliation":[{"name":"Western University","place":["London, Canada"]},{"name":"Robarts Research Institute","place":["London, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Eric","family":"Tarride","sequence":"additional","affiliation":[{"name":"McMaster University","place":["Hamilton, Canada"]},{"name":"McMaster University","place":["Hamilton, Canada"]},{"name":"The Research Institute of St. Joe\u2019s Hamilton, St. Joseph\u2019s Healthcare Hamilton","place":["Hamilton, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000257974.06317.49"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.013977"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506930"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.0000000000000375"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.0079"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14687"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200220001-00004"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2007.02188.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7547-7-9"},{"key":"e_1_3_2_11_2","volume-title":"Guidelines for the Economic Evaluation of Health Technologies: Canada","year":"2017","unstructured":"Guidelines for the Economic Evaluation of Health Technologies: Canada. 4th ed. 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