Abstract
Objective:
To examine healthcare costs among patients hospitalized for transient ischemic attack or ischemic stroke (TIA/stroke) and prescribed aspirin plus extended-release dipyridamole (ASA-ERDP) or clopidogrel (CLOPID) within 30 days post-discharge using a retrospective claims database from a large US managed care organization.
Methods:
Adult patients with ≥1 hospitalizations for TIA/stroke between January 2007–July 2009 and ≥1 claims for an oral anti-platelet (OAP) were observed for 1 year before and after the first TIA/stroke hospitalization or until death, whichever came first. Cohorts were defined by the first claim for ASA-ERDP or CLOPID within 30 days post-discharge. A generalized linear model, adjusting for demographics, baseline comorbidities and costs, compared total follow-up costs (medical + pharmacy) between ASA-ERDP and CLOPID patients.
Results:
Of 6377 patients (2085 ASA-ERDP; 4292 CLOPID) who met the selection criteria, mean (SD) age was 69 (13) years and 50% were male. Unadjusted mean total follow-up costs were lower for ASA-ERDP than CLOPID ($26,201 vs $30,349; p = 0.002), of which average unadjusted medical and pharmacy costs were $22,094 vs $26,062 (p = 0.003) and $4107 vs $4288 (p = 0.119), respectively. Multivariate modeling indicated that the following were associated with higher total costs (all p < 0.05): higher baseline Quan-Charlson comorbidity score, history of atrial fibrillation and myocardial infarction, index stroke hospitalization, death post-discharge, and index CLOPID use. Adjusted mean total follow-up costs for CLOPID were 9% higher than ASA-ERDP (cost ratio: 1.09; p = 0.038).
Conclusion:
In this study, compared to CLOPID patients, ASA-ERDP patients were observed to have lower total costs 1 year post-discharge TIA/stroke hospitalization, driven primarily by lower medical costs. Further research into the real-world impact of OAP therapies on clinical and economic outcomes of patients with stroke/TIA is warranted. The findings of this study should be considered within the limitations of an administrative claims analysis, as claims data are collected for the purpose of payment.
Keywords::
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Declaration of funding
Funding for this study was provided by Boehringer Ingelheim Pharmaceuticals, Inc.
Declaration of financial/other relationships
T.B., M.L., and F.L. have disclosed that they are employed by OptumInsight, a company funded by Boehringer Ingelheim to conduct this study. M.L.M. disclosed that she was employed by PharmaNet/i3, a company that provided medical consultation for this study, which was paid for by the sponsor. K.L. disclosed that she was employed by Boston Health Economics, Inc., the company that provided statistical consultation for this study, and also paind for by the sponsor. Y.Y and S.S. have disclosed that they are employed by Boehringer Ingelheim Pharmaceuticals, Inc., the company that funded this study.