COST CONSIDERATIONS IN THE PHARMACOLOGICAL PREVENTION AND TREATMENT OF STROKE

Stroke remains the leading cause of neurological disability and the th ird leading cause of death worldwide, consuming a large share of total healthcare expenditures. In this review, we discuss the cost effectiv eness of stroke prevention for various risk factor-modification progra mmes and pharmacological interventions with aspirin (acetylsalicylic a cid), ticlopidine and warfarin. Cost considerations and potential cost savings resulting from acute treatment are discussed for parenterally administered anticoagulants, such as heparin and nadroparin, and for intravenous thrombolysis with alteplase (recombinant tissue plasminoge n activator; r-tPA). Patients with multiple risk factors for stroke re quire more aggressive prevention strategies which are associated with a greater risk of complications. The rates of complications, particula rly intracerebral haemorrhage, should be kept low to achieve cost bene fits for warfarin and alteplase. Reduced hospital length of stay is th e key factor in the implementation of cost-effective stroke therapies. The analysis of future clinical trials of new stroke therapies should also include economic parameters, such as length of hospital stay and intensity of resource usage, to help guide formulary and therapeutic decisions.