BACKGROUND: Ticlopidine, an antiplatelet agent, when compared with aspirin has been found to reduce the risk of stroke in high-risk patients, ie, those with recent transient ischemic attack, reversible ischemic neurological deficit, amaurosis fugax, or minor stroke. Its cost-effectiveness in such use, however, is unknown. METHODS: We developed a model of primary stroke prevention in which a hypothetical cohort of 100 high-risk men and women 65 years of age was assumed to receive either ticlopidine (500 mg daily) or aspirin (1300 mg daily). Using published data, we estimated lifetime incidence of stroke, life expectancy (unadjusted and adjusted for changes in quality of life), and lifetime medical care costs associated with each therapy. RESULTS: Patients who receive ticlopidine would experience two fewer initial strokes per hundred than those treated with aspirin. Life expectancy would be extended by approximately one-half month, and lifetime medical care costs (discounted at 5%) would increase by about $2300. The cost-effectiveness of ticlopidine, compared with aspirin, is estimated to range from $31,200 to $55,500 per quality-adjusted life-year gained as the utility of life after nonfatal stroke is assumed to vary from 0.75 to 0.95. CONCLUSIONS: Ticlopidine therapy to prevent stroke in high-risk patients is cost-effective by current standards of medical practice.
BACKGROUND:Ticlopidine, an antiplatelet agent, when compared with aspirin has been found to reduce the risk of stroke in high-risk patients, ie, those with recent transient ischemic attack, reversible ischemic neurological deficit, amaurosis fugax, or minor stroke. Its cost-effectiveness in such use, however, is unknown. METHODS: We developed a model of primary stroke prevention in which a hypothetical cohort of 100 high-risk men and women 65 years of age was assumed to receive either ticlopidine (500 mg daily) or aspirin (1300 mg daily). Using published data, we estimated lifetime incidence of stroke, life expectancy (unadjusted and adjusted for changes in quality of life), and lifetime medical care costs associated with each therapy. RESULTS:Patients who receive ticlopidine would experience two fewer initial strokes per hundred than those treated with aspirin. Life expectancy would be extended by approximately one-half month, and lifetime medical care costs (discounted at 5%) would increase by about $2300. The cost-effectiveness of ticlopidine, compared with aspirin, is estimated to range from $31,200 to $55,500 per quality-adjusted life-year gained as the utility of life after nonfatal stroke is assumed to vary from 0.75 to 0.95. CONCLUSIONS:Ticlopidine therapy to prevent stroke in high-risk patients is cost-effective by current standards of medical practice.
Authors: Erqi L Pollom; Kyueun Lee; Ben Y Durkee; Madeline Grade; Daniel A Mokhtari; Daniel R Wahl; Mary Feng; Nishita Kothary; Albert C Koong; Douglas K Owens; Jeremy Goldhaber-Fiebert; Daniel T Chang Journal: Radiology Date: 2017-01-03 Impact factor: 11.105
Authors: Theresa I Shireman; Kaijun Wang; Jeffrey L Saver; Mayank Goyal; Alain Bonafé; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Reza Jahan; Katherine A Vilain; John House; Jin-Moo Lee; David J Cohen Journal: Stroke Date: 2016-12-27 Impact factor: 7.914