Aspirin plus extended-release dipyridamole or clopidogrel compared with aspirin monotherapy for the prevention of recurrent ischemic stroke: A cost-effectiveness analysis
H. Shah et K. Gondek, Aspirin plus extended-release dipyridamole or clopidogrel compared with aspirin monotherapy for the prevention of recurrent ischemic stroke: A cost-effectiveness analysis, CLIN THER, 22(3), 2000, pp. 362-370
Objective: The goal of this health economic analysis was to asses the cost-
effectiveness of a fixed combination of aspirin plus extended-release dipyr
idamole (ASA/ER-DP) or clopidogrel compared with ASA monotherapy for preven
tion of recurrent ischemic stroke.
Background: The second European Stroke Prevention Study (ASA/ESPS-2), a lar
ge scale clinical trial, demonstrated that a new therapy-a fixed combinatio
n of ASA/ER-DP-is more effective than ASA monotherapy for the prevention of
recurrent ischemic stroke.
Methods: We used data from ESPS-2 to create a health economic model that es
timates the incremental cost and cost-effectiveness of ASA/ER-DP during the
2-year time frame after an ischemic stroke. The modal was developed from a
payor perspective. The analysis used direct cost estimates for stroke from
a Medicare claims database analysis. Efficacy data were obtained From clin
ical trials to determine the incremental cost per stroke averted for ASA/ER
-DP or clopidogrel versus ASA. Sensitivity analyses also were con ducted to
test the reliability and robustness of the model.
Results: The results of the analysis demonstrated that ASA/ER-DP was cost-e
ffective compared with ASA monotherapy for the secondary prevention of stro
ke, with a cost-effectiveness ratio of $28,472. The model remained robust o
ver a range of assumptions and cost estimates. Clopidogrel, however, was no
t cost-effective compared with ASA (cost per stroke averted, $161,316) in e
ither the base-case analysis or any of the sensitivity analyses.
Conclusion: ASA/ER-DP thus Offers a cost-effective alternative to ASA monot
herapy for the prevention of recurrent ischemic stroke.