Cost-Effectiveness Analysis of Antiplatelet Therapy in the Prevention of Recurrent Stroke in Taiwan

• Main Authors: Ya-Ting Chang, 張雅婷
• Other Authors: 許光陽
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/69272776287261887291

碩士 === 臺北醫學大學 === 藥學研究所 === 96 === Background： Antiplatelet agents can prevent recurrent stroke. Aspirin is the most widely studied one and, until recently, it was the only drug used broadly for this purpose. Now, clinical trials indicate that ticlopidine, clopidogrel, and a combination regimen, aspirin plus modified-release dipyridamole (ASA+MR-DP), are also effective for prevention of recurrent stroke. However, these new antiplatelet agents are more expensive than aspirin. In Taiwan, their cost-effectiveness ratios relative to aspirin have not been estimated. Method： Markov model is developed to measure the clinical benefit and economic consequences of the following strategies to treat high-risk patients aged 65 years or older: (1) aspirin 100mg once a day; (2) aspirin 25mg plus modified-release dipyridamole 200mg (ASA+MR-DP) twice a day; and (3) clopidogrel 75mg once a day. Input data were obtained from literature review. Cost and quality-adjusted life-year (QALY) are primary outcomes measured. The time frame is two years. Results： The use of aspirin combined with dipyridamole was slightly effective and more costly compared the use of aspirin: direct cost per one patient is NTD 45,310, and estimated QALY for one patient is 1.948 years; in aspirin group: direct cost per one patient is NTD 33,623, and estimated QALY for one patient is 1.946 years. The Incremental cost-effectiveness ratio (ICER) between aspirin and ASA+MR-DP is NTD 1,889,544 per QALY. The comparison between aspirin and clopidogrel: The incremental cost-effectiveness ratio between aspirin and clopidogrel is NTD 9,699,399 per QALY. In sensitivity analyses, the efficacy and drug prices of antiplatelet agents are key factors to determine the ICER compared with aspirin. Conclusion： Comparing new antiplatelet agents to aspirin, our results show that using new drugs is cost-effective, it means using new drug has better outcome, but induces highly medical direct cost.