Cost–effectiveness of antiplatelet therapy for secondary stroke prevention

Abstract

Antiplatelet therapy is recommended over anticoagulants for the secondary prevention of vascular death in patients with noncardioembolic ischemic stroke or transient ischemic attack based upon the 2006 American Heart Association/American Stroke Association guidelines for the prevention of stroke and the National Stroke Association guidelines for the management of transient ischemic attack. Aspirin is commonly used as a cornerstone antiplatelet agent considering its mild but definite prevention benefit and low costs. Other antiplatelet strategies that are currently recommended include extended-release dipyridamole plus low-dose aspirin (Aggrenox^®, Asasantin^®) and clopidogrel. In this brief review, we evaluate the cost–effectiveness of antiplatelet agents for secondary stroke prevention to better understand the socioeconomical value of the recommended agents.

Keywords::

• antiplatelet therapy
• aspirin
• clopidogrel
• cost–effectiveness
• dipyridamole
• stroke prevention

Financial disclosure

Carla Zema and Stephen Sander are employees of Boehringer Ingelheim. Darya Malinina has no relevant financial interests related to this manuscript, including employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending. Victor Serebruany reports receiving consulting fees from Pfizer, Merck, Sanofi-Aventis, Bristol-Myers Squibb, Astra Zeneca, Daichii-Sankyo, Cardax Pharma, Johnson and Johnson, Eisai, Bayer, Boehringer Ingelheim, Fibrex Pharma; Novartis, mutual funds, and hedge funds; receiving grant support from Pfizer, Merck, Sanofi-Aventis, Cardax Pharma, Johnson and Johnson, Bayer, Boehringer Ingelheim, Fibrex Pharma, Novartis and AtheroGenics. He is listed as an inventor for issued or pending patent applications assigned to HeartDrug Research LLC, Duke University, Pfizer, AtheroGenics, Novartis and Lilly.