Aspirin plus extended-release dipyridamole or clopidogrel compared with aspirin monotherapy for the prevention of recurrent ischemic stroke: A cost-effectiveness analysis

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.