COST-EFFECTIVENESS OF TICLOPIDINE IN PREVENTING STROKE IN HIGH-RISK PATIENTS

Background Ticlopidine, an antiplatelet agent, when compared with aspi rin has been found to reduce the risk of stroke in high-risk patients, ie, those with recent transient ischemic attack, reversible ischemic neurological deficit, amaurosis fugax, or minor stroke. Its cost-effec tiveness in such use, however, is unknown. Methods We developed a mode l of primary stroke prevention in which a hypothetical cohort of 100 h igh-risk men and women 65 years of age was assumed to receive either t iclopidine (500 mg daily) or aspirin (1300 mg daily). Using published data, we estimated lifetime incidence of stroke, life expectancy (unad justed and adjusted for changes in quality of life), and lifetime medi cal care costs associated with each therapy. Results Patients who rece ive ticlopidine would experience two fewer initial strokes per hundred than those treated with aspirin. Life expectancy would be extended by approximately one-half month, and lifetime medical care costs (discou nted at 5%) would increase by about $2300. The cost-effectiveness of t iclopidine, compared with aspirin, is estimated to range from $31 200 to $55 500 per quality-adjusted life-year gained as the utility of lif e after nonfatal stroke is assumed to vary from 0.75 to 0.95. Conclusi ons Ticlopidine therapy to prevent stroke in highrisk patients is cost -effective by current standards of medical practice.