Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke

Zhou, Lily; Kraler, Lironn; Havenon, Adam de; Lansberg, Maarten G.

doi:10.1161/jaha.121.024992

Cited by 4 publications

(3 citation statements)

References 25 publications

(24 reference statements)

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“…Yet another study has previously demonstrated that the addition of cilostazol to aspirin or clopidogrel is cost-effective in patients with non-cardioembolic strokes. 28 However, no previous stroke studies have compared cost-effectiveness of genotype-guided therapy with empiric ticagrelor and aspirin.…”

Section: Discussionmentioning

confidence: 99%

Empiric treatment with aspirin and ticagrelor is the most cost-effective strategy in patients with minor stroke or transient ischemic attack

Narasimhalu,

Chan,

Ang

et al. 2023

International Journal of Stroke

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Background: Patients with minor ischemic stroke or transient ischemic attacks (TIAs) are often treated with dual antiplatelet therapy regimens as part of secondary stroke prevention. Clopidogrel, an antiplatelet used in these regimens, is metabolised into its active form by the CYP2C19 enzyme. Patients with loss of function (LOF) mutations in CYP2C19 are at risk for poorer secondary outcomes when prescribed clopidogrel Aims: We aimed to determine the cost effectiveness of three different treatment antiplatelet regimens in ischemic stroke populations with minor strokes or TIAs and how these treatment regimens are influenced by the LOF prevalence in the population. Methods: Markov models were developed to look at the cost effectiveness of empiric treatment with aspirin and clopidogrel versus empiric treatment with aspirin and ticagrelor, versus genotype guided therapy for either 21 or 30 days. Effect ratios were obtained from the literature and incidence rates and costs were obtained from the national data published by the Singapore Ministry of Health. The primary endpoints were the incremental cost-effectiveness ratios (ICERs). Results: Empiric treatment with aspirin and ticagrelor was the most cost-effective treatment. Genotype guided therapy was more cost effective than empiric aspirin and clopidogrel if the LOF was above 48%. Empiric ticagrelor and aspirin was cost saving when compared to genotype guided therapy. Results in models of dual antiplatelet therapy for 30 days were similar. Conclusion: This study suggests that in patients with minor stroke and TIA planned for dual antiplatelet regimens, empiric ticagrelor and aspirin is the most cost-effective treatment regimen. If ticagrelor is not available, genotype guided therapy is the most cost-effective treatment regimen if the LOF prevalence in the population is more than 48%.

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Section: Discussionmentioning

confidence: 99%

Empiric treatment with aspirin and ticagrelor is the most cost-effective strategy in patients with minor stroke or transient ischemic attack

Narasimhalu,

Chan,

Ang

et al. 2023

International Journal of Stroke

View full text Add to dashboard Cite

show abstract

“…A Canadian group 25 has previously shown that genotype guided therapy with patients with LOF mutations being given ticagrelor is cost effective at a threshold of $50,000 CAD per QALY. Yet another study has previously demonstrated that the addition of cilostazol to aspirin or clopidogrel is cost effective in patients with non-cardioembolic strokes 26 . However, no previous stroke studies have compared cost effectiveness of genotype guided therapy with empiric ticagrelor and aspirin.…”

Section: Discussionmentioning

confidence: 99%

Empiric treatment with aspirin and ticagrelor is the most cost-effective strategy in patients with minor stroke or transient ischemic attack

Narasimhalu

Chan

Ang

et al. 2023

Preprint

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Background: Patients with minor ischemic stroke or transient ischemic attacks (TIAs) are often treated with dual antiplatelet therapy regimens as part of secondary stroke prevention. Clopidogrel, an antiplatelet used in these regimens, is metabolised into its active form by the CYP2C19 enzyme. Patients with loss of function (LOF) mutations in CYP2C19 are at risk for poorer secondary outcomes when prescribed clopidogrel. We aimed to determine the cost effectiveness of three different treatment antiplatelet regimens in ischemic stroke populations with minor strokes or TIAs and how these treatment regimens are influenced by the LOF prevalence in the population. Methods: Markov models were developed to look at the cost effectiveness of empiric treatment with aspirin and clopidogrel versus empiric treatment with aspirin and ticagrelor, versus genotype guided therapy for either 21 or 30 days. Effect ratios were obtained from the literature and incidence rates and costs were obtained from the national data published by the Singapore Ministry of Health. The primary endpoints were the incremental cost-effectiveness ratios (ICERs). Results: Empiric treatment with aspirin and ticagrelor was the most cost-effective treatment regimen if the prevalence of LOF was above 7.5%. Genotype guided therapy was more cost effective than empiric aspirin and clopidogrel if the LOF was above 65.5%. Empiric ticagrelor and aspirin was cost saving when compared to genotype guided therapy. Results in models of dual antiplatelet therapy for 30 days were similar. Conclusion: This study suggests that in patients with minor stroke and TIA planned for dual antiplatelet regimens, empiric ticagrelor and aspirin is the most cost-effective treatment regimen. If ticagrelor is not available, genotype guided therapy is the most cost-effective treatment regimen if the LOF prevalence in the population is more than 65.5%.

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“…Several studies have shown that single aspirin is more effective than clopidogrel [10,11]. Several trials have tested the efficacy and safety of clopidogrel and aspirin versus aspirin in preventing recurrent stroke in ischemic stroke [12][13][14]. A metaanalysis from 2018 found that an aspirin-clopidogrel combination given within 24 hours of an ischemic stroke also reduced the risk of recurrent stroke [15].…”

Section: Introductionmentioning

confidence: 99%

Evaluating Economic Outcomes: Single-Use Aspirin vs. Aspirin-Clopidogrel in Ischemic Stroke Patients Based on Barthel Index Scores

Yosmar,

Febiana,

Fitria

2023

J Sains Farm Klin

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Ischemic stroke is a catastrophic disease that causes large costs in Indonesia. The high prevalence of stroke results in increased morbidity and mortality rates, which will impact the socioeconomic status of stroke patients. Cost Effectiveness Analysis (CEA) is a method in pharmaco-economics that aims to make decisions regarding the rational choice of therapy and evaluate the economic impact on ischemic stroke patients. This study aims to determine the Incremental Cost Effectiveness Ratio (ICER) value of antiplatelet therapy in the aspirin-clopidogrel combination group and the single aspirin group in ischemic stroke patients treated at the Regional General Hospital. Dr. M. Djamil Padang. The clinical parameter observed was the Barthel Index (BI) value. This research is a descriptive study with retrospective data collection using medical record data and the Hospital Management Information System (SIMRS) at RSUD Dr. M.Djamil Padang. The cost data shows the total direct medical costs incurred in treating ischemic stroke. Based on the results obtained, the Incremental Cost Effectiveness Ratio (ICER) value is IDR (-) 401,302. 71 per 1% increase. In this study it can be concluded that the aspirin-clopidogrel combination has better cost effectiveness than aspirin alone.

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Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke

Cited by 4 publications

References 25 publications

Empiric treatment with aspirin and ticagrelor is the most cost-effective strategy in patients with minor stroke or transient ischemic attack

Empiric treatment with aspirin and ticagrelor is the most cost-effective strategy in patients with minor stroke or transient ischemic attack

Empiric treatment with aspirin and ticagrelor is the most cost-effective strategy in patients with minor stroke or transient ischemic attack

Evaluating Economic Outcomes: Single-Use Aspirin vs. Aspirin-Clopidogrel in Ischemic Stroke Patients Based on Barthel Index Scores

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