Table 3 Utility decrements for bleeding events during dual antiplatelet therapy from decision analytic models
Author [ref] | Hypothetical patient population modelled | Antiplatelet regime | Definition and categorisation of bleeding | Instrument and population used to measure QoL | Valuation method | Utility decrements for minor bleeds | Utility decrements for major bleeds | Utility decrements for other bleeds |
|---|---|---|---|---|---|---|---|---|
Greenhalgh [27] | Four subgroups: ACS with PCI for STEMI with and without T2DM; and ACS with PCI for UA or NSTEMI with and without T2DM | DAPT – prasugrel plus low-dose aspirin compared to clopidogrel plus low-dose aspirin | MS model definition for bleed does not exclude CABG-related bleeds; non-fatal bleeds not treated as on-going health states within model [such events incur only temporary reduction (14 days) in HRQoL] | MS: EQ-5D-3 L; UK population norms | MS: Time trade-off techniques | NR | MS: 25% decrement to UK population norms (free of disease) for 14 days; equal to a disutility of − 0.007 | NR |
Garg [28] | ACS with PCI (i.e., DES) | DAPT - clopidogrel plus low-dose aspirin; durations of 12 and 30 months | Major and minor bleeds based on TIMI bleeding risk score [disutility applied during the year in which event occurred] | NR – see Additional file 1: Appendix E for more details | NR – see Additional file 1: Appendix E for more details | −0.002 | − 0.025 | NR |
Kazi [29] | ACS with PCI | Five strategies: 1) generic clopidogrel; 2) prasugrel; 3) ticagrelor; 4) CYP2C19 carriers ticagrelor and noncarriers clopidogrel; 5) CYP2C19 carriers prasugrel and noncarriers clopidogrel | Minor haemorrhage and CABG-related bleeding based on TIMI bleeding risk score and extracranial haemorrhage based on TIMI score | NR – see Additional file 1: Appendix E for more details | NR – see Additional file 1: Appendix E for more details | 0.2 for 2 days (− 0.004) | NR | Extra-cranial: 0.2 for 14 days (− 0.0308) CABG-related bleed: 0.5 for 7 days (− 0.01) |
Liew [30] | ACS (trial data used included patients scheduled to undergo medical or invasive management (e.g., PCI or CABG) | DAPT – ticagrelor plus aspirin compared to clopidogrel plus aspirin | No clinical definitions reported [disutilities applied during the cycle (1-year cycle length) in which the event occurred] | EQ-5D-3 L | NR | −0.02 | − 0.05 | NR |
Gupta [31] | CAS with PCI receiving either DES or BMS | DAPT - clopidogrel plus aspirin | GI bleeding | Based on the average duration of hospitalisation | NA | NR | NR | GI haemorrhage: toll of 6 days (− 0.016) |
Schleinitz [32] | High-risk ACS: unstable angina and electrocardiographic changes or non-Q-wave MI | DAPT – clopidogrel plus aspirin compared to aspirin alone | GI bleeding | Assumption | NA | NR | NR | GI bleeding: − 0.005 |
Latour-Perez [33] | NSTEMI ACS with hospital admission | DAPT - clopidogrel plus aspirin compared to aspirin alone | GI bleeding [disutility only counted in the cycle (1-month cycle length) in which it occurred] | NR – see Additional file 1: Appendix E for more details | NR – see Additional file 1: Appendix E for more details | NR | NR | Serious haemorrhage disutility − 0.13; GI bleeding referred to in methods section, but no associated disutility value reported |
Jiang [34] | ACS with PCI | DAPT – Three strategies: 1) clopidogrel plus aspirin; 2) prasugrel or ticagrelor plus aspirin; and 3) CYP2C19 LOF/GOF allele prasugrel or ticagrelor plus aspirin and wild type clopidogrel plus aspirin | Nonfatal bleeding | NR – see Additional file 1: Appendix E for more details | NR – see Additional file 1: Appendix E for more details | NR | NR | Nonfatal bleeding: −0.250 |
Wang [35] | 60-year old Chinese (North Asian) ACS patients who underwent PCI | DAPT – Three strategies: 1) clopidogrel plus aspirin; 2) ticagrelor plus aspirin; and 3) CYP2C19*2 allele carriers receive ticagrelor plus aspirin and wild type clopidogrel plus aspirin | Bleeding | NR – see Additional file 1: Appendix E for more details | NR – see Additional file 1: Appendix E for more details | NR | NR | Bleeding: − 0.02 |
Jiang [36] | 60-year old ACS patients undergoing PCI | DAPT – Four strategies: 1) clopidogrel plus aspirin; 2) prasugrel or ticagrelor plus aspirin; 3) CYP2C19 LOF/GOF allele prasugrel or ticagrelor plus aspirin and wild type clopidogrel plus aspirin; and 4) low responders (PRU > 208) clopidogrel loading dose followed by prasugrel or ticagrelor plus aspirin and normal responders (PRU ≤ 208) clopidogrel plus aspirin. | Nonfatal bleeding | NR – see Additional file 1: Appendix E for more details | NR – see Additional file 1: Appendix E for more details | NR | NR | Nonfatal bleeding: −0.250 |