Cost-effectiveness of New Antiplatelet Regimens Used as Secondary Prevention of Stroke or Transient Ischemic Attack

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Abstract
MANY CLINICAL trials1 have evaluated the benefit of long-term use of aspirin in reducing the risk of thrombotic events. Specifically, it reduces the relative risk of stroke and death from vascular events, such as myocardial infarction (MI), by about 25% compared with placebo. Recently, 2 other antiplatelet regimens, clopidogrel bisulfate, a thienopyridine derivative like ticlopidine hydrochloride, and a new formulation of dipyridamole combined with aspirin, were reported in large clinical trials2,3 to further reduce the risk of vascular events compared with aspirin. Both regimens were recently approved by the Food and Drug Administration for secondary prevention of stroke. However, despite their increased efficacy when compared with aspirin, both clopidogrel and, to a lesser extent, dipyridamole combined with aspirin are more expensive than aspirin alone. In 2 recent review articles4,5 on this topic, the authors thought that the new regimens were very expensive alternatives to aspirin for secondary prevention of stroke. However, a formal cost-effectiveness analysis is still lacking.