{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:13:47Z","timestamp":1753892027915,"version":"3.41.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T00:00:00Z","timestamp":1647561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Although ticagrelor plus aspirin is more effective than aspirin alone in preventing the 30-day risk of a composite of stroke or death in patients with an acute mild-to-moderate ischemic stroke (IS) or transient ischemic attack (TIA), the cost-effectiveness of this combination therapy remains unknown. This study aims to determine the cost-effectiveness of ticagrelor plus aspirin compared with aspirin alone.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A combination of decision tree and Markov model was built to estimate the expected costs and quality-adjusted life-years (QALYs) associated with ticagrelor plus aspirin and aspirin alone in the treatment of patients with an acute mild-to-moderate IS or TIA. Model inputs were extracted from published sources. One-way sensitivity, probabilistic sensitivity, and subgroup analyses were performed to test the robustness of the findings.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Compared with aspirin alone, ticagrelor plus aspirin gained an additional lifetime QALY of 0.018 at an additional cost of the Chinese Yuan Renminbi (\u00a5) of 269, yielding an incremental cost-effectiveness ratio of \u00a515,006 (US$2,207)\/QALY. Probabilistic sensitivity analysis showed that ticagrelor plus aspirin had a probability of 99.99% being highly cost-effective versus aspirin alone at the current willingness-to-pay threshold of \u00a572,447 (US$10,500)\/QALY in China. These findings remain robust under one-way sensitivity and subgroup analyses.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The results indicated that early treatment with a 30-days ticagrelor plus aspirin for an acute mild-to-moderate IS or TIA is highly cost-effective in a Chinese setting.<\/jats:p>","DOI":"10.3389\/fphar.2022.790048","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T06:04:48Z","timestamp":1647583488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Economic Evaluation of Ticagrelor Plus Aspirin Versus Aspirin Alone for Acute Ischemic Stroke and Transient Ischemic Attack"],"prefix":"10.3389","volume":"13","author":[{"given":"Jigang","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linjin","family":"Ji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Tong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingyang","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Songfeng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongkai","family":"Qin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zilong","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiqun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aihua","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1001\/jamaneurol.2020.4396","article-title":"Ticagrelor Added to Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack in Prevention of Disabling Stroke: a Randomized Clinical Trial","volume":"78","author":"Amarenco","year":"2021","journal-title":"JAMA Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1641","DOI":"10.1016\/s0140-6736(97)04010-5","article-title":"CAST: Randomised Placebo-Controlled Trial of Early Aspirin Use in 20,000 Patients with Acute Ischaemic Stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group","volume":"349","author":"Chen","year":"1997","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1161\/STROKEAHA.108.540138","article-title":"Cost-effectiveness of Patient Selection Using Penumbral-Based MRI for Intravenous Thrombolysis","volume":"40","author":"Earnshaw","year":"2009","journal-title":"Stroke"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1161\/01.str.29.6.1083","article-title":"Cost-effectiveness of Preference-Based Antithrombotic Therapy for Patients with Nonvalvular Atrial Fibrillation","volume":"29","author":"Gage","year":"1998","journal-title":"Stroke"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2591","DOI":"10.1161\/STROKEAHA.115.009396","article-title":"Cost-utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke","volume":"46","author":"Ganesalingam","year":"2015","journal-title":"Stroke"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/S1474-4422(07)70274-0","article-title":"Risk of Stroke Early after Transient Ischaemic Attack: a Systematic Review and Meta-Analysis","volume":"6","author":"Giles","year":"2007","journal-title":"Lancet Neurol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1056\/NEJM199309023291001","article-title":"An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction","volume":"329","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"80f1049","DOI":"10.1186\/1741-7015-11-80","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement","volume":"11","author":"Husereau","year":"2013","journal-title":"BMC Med."},{"key":"B9","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/S0140-6736(97)04011-7","article-title":"The International Stroke Trial (IST): a Randomised Trial of Aspirin, Subcutaneous Heparin, Both, or Neither Among 19435 Patients with Acute Ischaemic Stroke. International Stroke Trial Collaborative Group","volume":"349","year":"1997","journal-title":"Lancet"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2901","DOI":"10.1001\/jama.284.22.2901","article-title":"Short-term Prognosis after Emergency Department Diagnosis of TIA","volume":"284","author":"Johnston","year":"2000","journal-title":"JAMA"},{"key":"B11","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1056\/nejmoa1800410","article-title":"Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA","volume":"379","author":"Johnston","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1056\/NEJMoa1916870","article-title":"Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA","volume":"383","author":"Johnston","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1136\/svn-2016-000063","article-title":"A Literature Review of Cost-Effectiveness of Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke","volume":"2","author":"Joo","year":"2017","journal-title":"Stroke Vasc. Neurol."},{"key":"B14","unstructured":"Health Care and Personal Articles of Consumer Price Indices2020"},{"key":"B15","unstructured":"The 2010 Population Census of the People\u2019s Republic of China2021"},{"key":"B16","unstructured":"2021"},{"volume-title":"China Health Statistics Yearbook 2019","year":"2019","key":"B17"},{"key":"B18","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1177\/1357633X15613920","article-title":"The Cost-Effectiveness of Telestroke in the Pacific Northwest Region of the USA","volume":"22","author":"Nelson","year":"2016","journal-title":"J. Telemed. Telecare"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1517\/14656566.2012.699522","article-title":"Cost-effectiveness of Stroke Treatments and Secondary Preventions","volume":"13","author":"Pan","year":"2012","journal-title":"Expert Opin. Pharmacother."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e000912","DOI":"10.1161\/JAHA.114.000912","article-title":"Cost-effectiveness of Clopidogrel-Aspirin versus Aspirin Alone for Acute Transient Ischemic Attack and Minor Stroke","volume":"3","author":"Pan","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"B21","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1161\/CIRCULATIONAHA.116.024913","article-title":"Genetic Polymorphisms and Clopidogrel Efficacy for Acute Ischemic Stroke or Transient Ischemic Attack: a Systematic Review and Meta-Analysis","volume":"135","author":"Pan","year":"2017","journal-title":"Circulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e018951","DOI":"10.1136\/bmjopen-2017-018951","article-title":"Cost-effectiveness of Mechanical Thrombectomy within 6 hours of Acute Ischaemic Stroke in China","volume":"8","author":"Pan","year":"2018","journal-title":"BMJ Open"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1161\/STROKEAHA.119.027980","article-title":"Cost-Effectiveness of a Multifaceted Quality Improvement Intervention for Acute Ischemic Stroke in China","volume":"51","author":"Pan","year":"2020","journal-title":"Stroke"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1161\/STROKEAHA.114.005060","article-title":"Long-term Risk and Predictors of Recurrent Stroke beyond the Acute Phase","volume":"45","author":"Pennlert","year":"2014","journal-title":"Stroke"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e2012476","DOI":"10.1001\/jamanetworkopen.2020.12476","article-title":"Cost-effectiveness of Mechanical Thrombectomy More Than 6 hours after Symptom Onset Among Patients with Acute Ischemic Stroke","volume":"3","author":"Peultier","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e002433","DOI":"10.1161\/JAHA.115.002433","article-title":"Stroke Severity Is a Crucial Predictor of Outcome: an International Prospective Validation Study","volume":"5","author":"Rost","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/s0895-4356(98)00151-6","article-title":"Performing Cost-Effectiveness Analysis by Integrating Randomized Trial Data with a Comprehensive Decision Model: Application to Treatment of Acute Ischemic Stroke","volume":"52","author":"Samsa","year":"1999","journal-title":"J. Clin. Epidemiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/j.amjmed.2004.01.014","article-title":"Clopidogrel versus Aspirin for Secondary Prophylaxis of Vascular Events: a Cost-Effectiveness Analysis","volume":"116","author":"Schleinitz","year":"2004","journal-title":"Am. J. Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1161\/STROKEAHA.108.531533","article-title":"Causes of Death by Level of Dependency at 6 Months after Ischemic Stroke in 3 Large Cohorts","volume":"40","author":"Slot","year":"2009","journal-title":"Stroke"},{"key":"B30","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1215340","article-title":"Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack","volume":"369","author":"Wang","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1001\/jama.2018.8802","article-title":"Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients with Acute Ischemic Stroke in China: a Randomized Clinical Trial","volume":"320","author":"Wang","year":"2018","journal-title":"JAMA"},{"key":"B32","doi-asserted-by":"publisher","first-page":"105557","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105557","article-title":"Is Endovascular Therapy for Stroke Cost-Effective Globally? A Systematic Review of the Literature","volume":"30","author":"Waqas","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1001\/jama.276.15.1253","article-title":"Recommendations of the Panel on Cost-Effectiveness in Health and Medicine","volume":"276","author":"Weinstein","year":"1996","journal-title":"JAMA"},{"key":"B34","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/S1474-4422(18)30500-3","article-title":"Stroke in China: Advances and Challenges in Epidemiology, Prevention, and Management","volume":"18","author":"Wu","year":"2019","journal-title":"Lancet Neurol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1159\/000097047","article-title":"Recurrence after Ischemic Stroke in Chinese Patients: Impact of Uncontrolled Modifiable Risk Factors","volume":"23","author":"Xu","year":"2007","journal-title":"Cerebrovasc. Dis."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2022.790048\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T06:04:52Z","timestamp":1647583492000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2022.790048\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,18]]},"references-count":35,"alternative-id":["10.3389\/fphar.2022.790048"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2022.790048","relation":{},"ISSN":["1663-9812"],"issn-type":[{"type":"electronic","value":"1663-9812"}],"subject":[],"published":{"date-parts":[[2022,3,18]]},"article-number":"790048"}}