INTRODUCTION The efficacy of ticagrelor 90mg and aspirin (ticagrelor-aspirin) for the prevention of stroke following an ischaemic stroke (IS) or transient ischaemic attack (TIA) was evaluated in the Acute STroke or Transient IscHaemic Attack Treated With TicAgreLor and ASA for PrEvention of Stroke and Death (THALES, NCT03354429) trial. Ticagrelor-aspirin resulted in a 17% reduction in the risk of stroke or death over 30 days versus aspirin, but with more bleeding events. Ticagrelor 90mg is approved to reduce stroke risk in patients with acute IS (NIH Stroke Scale score ≤5) or high-risk TIA by the Food and Drug Administration.

OBJECTIVES : The objective of this study was to estimate the reduction in medical care costs associated with ticagrelor-aspirin from a US payer perspective.

METHODS THALES event rates were used to estimate incidence of IS, intracranial haemorrhage, other severe bleeding and death in a modelled cohort of 1,000 patients with IS or TIA over 30 days. Acute stroke management costs were derived using US claims from IBM® MarketScan® Databases 2019 and applied to the incidence of events.

RESULTS : Ticagrelor-aspirin was associated with 12 fewer IS compared to aspirin (49 versus 61) and three additional severe bleeding events (4 versus 1) per 1,000 treated patients. Total estimated medical care costs were $311,000 lower per 1,000 patients treated with ticagrelor-aspirin ($2.26M) versus aspirin ($2.57M); a per-patient reduction of $311. The reduction of IS events resulted in a per-patient reduction of $496 with ticagrelor-aspirin, primarily driven by a decrease in the incidence of IS resulting in disability, while additional bleeding events resulted in additional costs of $185 per patient treated with ticagrelor-aspirin.

CONCLUSIONS : IS and TIA impose a significant burden on both patients and payers; treatment with ticagrelor-aspirin has the potential to improve patient outcomes and result in cost-savings through the reduced incidence of subsequent ischaemic stroke.