Secondary prevention of stroke with antiplatelets - An economics analysis

ABSTRACT

The burden of stroke therapy has been ameliorated to a great extent with the use of anti-platelet agent for secondary prevention. The cost of health care in general is rising. Economic factors play a significant role in the cost of hospitalization for stroke patients in general and in the choice of anti-platelet agents in particular. The goal of this study is (1) to compare the total costs associated with prescription of anti-platelet drugs, (2) to determine the number-needed-to-treat (NNT) with each of the different anti-platelet drugs in the market: aspirin, dipyridamole, ticlopidine, cilostazol and clipidogrel; and (3) determine the direct cost incurred with the use of each anti-platelet drug. To do this, a cost-minimization analysis of total costs was done. Data were collected from all randomized control trials published evaluating drug treatment vs. placebo. Event rates, absolute risk reduction and NNT were calculated. Cost computation was done from direct medication and additional expenses were included for treatment or monitoring of adverse effects. Transportation and professional fees were excluded. The results of the study showed the following: NNT for ASA: 33; DP: 50; DP-ASA: 17; Ticlopidine: 33; Cilostazol: 17 and Clopidogrel: 100. Direct cost for two years treatment for ASA: Php13,678.90; DP: Php18,615.00, DP-ASA: Php3l,615.00, Ticlopidine: Php77,060.00, Cilostazol: Php64,240.00 and Clopidogrel: Php64,240,00. Total costs to prevent 1 stroke in two years treatment for ASA: Php451,403.70, DP: Php930,750.00, DP-ASA: Php537,455.00, Ticlopidine: Php2,542,980.00, Cilostazol: Phpl,092,080.00 and Clopidogrel: Php6,424,000.00. We conclude that aspirin should be the mainstay of therapy in preventing secondary stroke. (Author)