Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack
Background 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‐onset diabetes. Low‐dose pioglitazone provides most of the clinical benefits of high‐dose pioglitazone, with f...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-11-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.034531 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850219158006923264 |
|---|---|
| author | Fei Yuan J. David Spence Jean‐Eric Tarride |
| author_facet | Fei Yuan J. David Spence Jean‐Eric Tarride |
| author_sort | Fei Yuan |
| collection | DOAJ |
| description | Background 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‐onset diabetes. Low‐dose pioglitazone provides most of the clinical benefits of high‐dose pioglitazone, with fewer adverse effects. We report an economic evaluation of the cost‐effectiveness of low‐dose pioglitazone versus placebo from a Canadian public payer perspective in 2023 Canadian dollars. Methods and Results A Markov model was developed at a lifetime horizon with an annual cycle length and 5 health states (event‐free, myocardial infarction, stroke, new‐onset 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‐case analysis. Probabilistic analyses were conducted to deal with parameter uncertainty through 5000 simulations. The costs were estimated as $24 887 (interquartile range [IQR], $14 632–$41507) for low‐dose pioglitazone and $57 301 (IQR, $48 730–$67368) for placebo, resulting in a cost saving of −$30 287 (IQR, −$43 374 to −$14 587) in favor of low‐dose pioglitazone. Quality‐adjusted life years were estimated as 25.99 (IQR, 24.56–26.81) for the low‐dose pioglitazone and 19.44 (IQR, 18.68–20.13) for placebo, resulting in a difference of 6.37 (IQR, 5.07−7.36) in favor of low‐dose pioglitazone. Consistent findings were observed from scenario analyses and 1‐way probability sensitivity analyses. Conclusions Holding across a wide range of values in modeling parameters, low‐dose pioglitazone is found as the dominant strategy versus a placebo. |
| format | Article |
| id | doaj-art-9344df89fe5044c3ad30b21b98e57048 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-9344df89fe5044c3ad30b21b98e570482025-08-20T02:07:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-11-01132110.1161/JAHA.123.034531Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic AttackFei Yuan0J. David Spence1Jean‐Eric Tarride2Population Health Research Institute, DBCVSRI Hamilton ON CanadaNeurology & Clinical Pharmacology Western University London ON CanadaDepartment of Health Research Methods, Evidence and Impact, McMaster Chair in Health Technology Management McMaster University Hamilton ON CanadaBackground 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‐onset diabetes. Low‐dose pioglitazone provides most of the clinical benefits of high‐dose pioglitazone, with fewer adverse effects. We report an economic evaluation of the cost‐effectiveness of low‐dose pioglitazone versus placebo from a Canadian public payer perspective in 2023 Canadian dollars. Methods and Results A Markov model was developed at a lifetime horizon with an annual cycle length and 5 health states (event‐free, myocardial infarction, stroke, new‐onset 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‐case analysis. Probabilistic analyses were conducted to deal with parameter uncertainty through 5000 simulations. The costs were estimated as $24 887 (interquartile range [IQR], $14 632–$41507) for low‐dose pioglitazone and $57 301 (IQR, $48 730–$67368) for placebo, resulting in a cost saving of −$30 287 (IQR, −$43 374 to −$14 587) in favor of low‐dose pioglitazone. Quality‐adjusted life years were estimated as 25.99 (IQR, 24.56–26.81) for the low‐dose pioglitazone and 19.44 (IQR, 18.68–20.13) for placebo, resulting in a difference of 6.37 (IQR, 5.07−7.36) in favor of low‐dose pioglitazone. Consistent findings were observed from scenario analyses and 1‐way probability sensitivity analyses. Conclusions Holding across a wide range of values in modeling parameters, low‐dose pioglitazone is found as the dominant strategy versus a placebo.https://www.ahajournals.org/doi/10.1161/JAHA.123.0345315‐state aggregate Markov modelcost‐utility analysisincremental cost‐effect ratioincremental effect of outcomeincremental mean costprobability analysis |
| spellingShingle | Fei Yuan J. David Spence Jean‐Eric Tarride Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 5‐state aggregate Markov model cost‐utility analysis incremental cost‐effect ratio incremental effect of outcome incremental mean cost probability analysis |
| title | Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack |
| title_full | Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack |
| title_fullStr | Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack |
| title_full_unstemmed | Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack |
| title_short | Cost‐Utility Analysis of Low‐Dose Pioglitazone in a Population With Prediabetes and a History of Stroke or Transient Ischemic Attack |
| title_sort | cost utility analysis of low dose pioglitazone in a population with prediabetes and a history of stroke or transient ischemic attack |
| topic | 5‐state aggregate Markov model cost‐utility analysis incremental cost‐effect ratio incremental effect of outcome incremental mean cost probability analysis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.034531 |
| work_keys_str_mv | AT feiyuan costutilityanalysisoflowdosepioglitazoneinapopulationwithprediabetesandahistoryofstrokeortransientischemicattack AT jdavidspence costutilityanalysisoflowdosepioglitazoneinapopulationwithprediabetesandahistoryofstrokeortransientischemicattack AT jeanerictarride costutilityanalysisoflowdosepioglitazoneinapopulationwithprediabetesandahistoryofstrokeortransientischemicattack |