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)