APPLICATION OF THE FINDINGS OF THE EUROPEAN-STROKE-PREVENTION-STUDY-2(ESPS-2) TO A NEW-ZEALAND ISCHEMIC STROKE COST-ANALYSIS

The aim of this study was to apply the findings of the European Stroke Prevention Study 2 (ESPS-2) to a paper that quantified and described the annual cost of ischaemic stroke in New Zealand, and to compare the cost of alternative drug regimens in the secondary prevention of isch aemic stroke. Comparisons were made between the costs of low-dosage as pirin (acetylsalicylic acid) monotherapy and a combination of modified -release dipyridamole and low-dosage aspirin. Differences in undiscoun ted costs were calculated over a 2-year period. The New Zealand cost p er stroke event was multiplied by the ESPS-2 incremental reduction in stroke events to derive the cost of strokes avoided. As the focus of t he paper was on direct medical costs, the primary perspective adopted was that of a healthcare provider or funder, but a societal perspectiv e was also considered by evaluation of direct nonmedical and indirect costs. Compared with aspirin monotherapy, combination therapy generate d incremental net direct costs of 18.22 New Zealand dollars ($NZ) per patient or $NZ18 223 per 1000 patients. However, individually, each tr eatment regimen resulted in direct cost savings when compared with pla cebo: combination therapy $NZ905.16 per patient; aspirin monotherapy $ NZ923.39 per patient (a difference between the 2 regimens of $NZ18.22 per patient). Total direct and indirect incremental cost savings were $NZ40.96 per patient, and $NZ40 963 per 1000 patients, for the combina tion therapy. The analysis demonstrates that changing patients from lo w-dosage aspirin to a combination therapy of modified-release dipyrida mole plus low-dosage aspirin would result in a small rise in increment al direct costs (using our conservative assumptions relating to hospit al and continuing institutional care costs). If less conservative unit cost assumptions were adopted, a more likely outcome would be a savin g in direct incremental costs of up to $NZ400 per patient treated.