Cost-effectiveness of stroke treatments and secondary preventions.

INTRODUCTION: Stroke is one of the leading causes of morbidity and mortality worldwide. It imposes a significant burden in terms of costs, premature death, long-term disability, restricted social functioning and reduction in patient's quality of life. Effective interventions in stroke treatment and prevention have long-term clinical and economic consequences. AREAS COVERED: This review focuses on the cost-effective evaluations regarding the medical treatments of acute stroke and long-term secondary prevention of stroke. A comprehensive electronic search for economic evaluations in this area was conducted. Different economic modeling approaches, evidence considered in the evaluations and the key findings are all reviewed and discussed. EXPERT OPINION: Intravenous thrombolysis is consistently shown to be the most cost-effective option for acute stroke treatment. Clopidogrel, statin, warfarin and dabigatran are considered as the most cost-effective treatments for secondary stroke prevention. However, lack of long-term outcome data and long-term resource use data adds tremendous uncertainty to the cost-effectiveness stories of these treatments. Economic studies that are updated with more recent clinical findings and studies that seek to identify the cost-effective combinations of different types of treatments are warranted. Also, few of the published economic evaluations considered the economic impact of these treatments on subgroups and individuals with different risks.