Cost-Effectiveness of Primary Prevention of Stroke in Type 2 Diabetes in the United States: A Microsimulation Analysis.

Abstract

Implementation of guideline-recommended strategies to prevent acute ischemic stroke (AIS) in type 2 diabetes (T2D) remains suboptimal. We evaluated and compared the health impact and cost-effectiveness of improved implementation of guideline-recommended strategies for AIS prevention in patients with T2D in the United States. We compared scenarios with enhanced implementation of these prevention strategies to the status-quo using a microsimulation model. National Health and Nutrition Examination Survey (NHANES) 2015-2018 participants ≥ 45 years of age with T2D and no stroke history. We evaluated stroke-related events, costs, stroke-related quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net health benefit (NHB) from a health system perspective over a 10-year time horizon. A discount rate of 3% per year was applied to costs and QALYs. Costs were expressed in 2022 U.S. dollars. Full implementation of guideline-recommended blood pressure (BP), statin, and aspirin therapies, and smoking cessation would each be cost-saving or highly cost-effective (< $50,000 per QALY-gained). Over 10 years, full implementation of all four of the strategies would prevent 151,000 stroke events, 61,900 deaths from stroke, save $13.4 billion, and produce a nationwide increase of 1,552,000 QALYs (NHB). Recent attention has focused on the treatment of AIS. We demonstrate that substantial opportunities exist to improve the primary prevention of AIS in Americans with T2D. Providers and payers should prioritize adherence to guidelines for BP, statin and aspirin therapy, and smoking cessation for stroke prevention.