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METHODS: A markov decision model was developed with probability and cost derived primarily from published studies. A 50-year-old man was used as a reference case. The number of stroke-free life years gained was used as the clinical outcome, and the cost in U.S. dollars was used as the economic outcome. POPULATION STRATEGY: supplementing folic acid in all people aged over 50, and SELECTIVE INTERVENTION STRATEGY: supplementing it in people with MTHFR C677T TT genotype were compared using an expected stroke-free life years calculation and two types of sensitivity analyses: probabilistic and one-way sensitivity analyses. RESULTS: We found that POPULATION STRATEGY generates 0.08 higher stroke-free life years with $392 higher costs compared with SELECTIVE INTERVENTION STRATEGY. The incremental cost effectiveness ratio for population strategy and selective intervention strategy compared to no intervention were $2,294 and $1,299, respectively. One-way sensitivity analysis showed that cost-effectiveness was dependent on the probability of stroke, the adherence rate to folic acid supplementation, the cost of genotyping, and the cost of folic acid. When the genotyping cost is increased to $88, or the annual cost of folic acid is decreased to $5, selective intervention is dominated. 2nd order Monte Carlo simulation showed that if the decision-maker is prepared to pay $3,000 per stroke-free life years, then the probability of the selective intervention being cost-effective is 44.2 %. At a figure of $10,000 per stroke-free life years, the probability decreases to 0.02 %. CONCLUSION: Our study demonstrates that intervention targeting people with MTHFR C677T TT genotype has the potential to improve cost effectiveness of stroke prevention.
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)