Cargando…
Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke
BACKGROUND: The objective of the study was to assess the cost‐effectiveness of cilostazol (a selective phosphodiesterase 3 inhibitor) added to aspirin or clopidogrel for secondary stroke prevention in patients with noncardioembolic stroke. METHODS AND RESULTS: A Markov model decision tree was used t...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238703/ https://www.ncbi.nlm.nih.gov/pubmed/35656996 http://dx.doi.org/10.1161/JAHA.121.024992 |
_version_ | 1784737120707936256 |
---|---|
author | Zhou, Lily W. Kraler, Lironn de Havenon, Adam Lansberg, Maarten G. |
author_facet | Zhou, Lily W. Kraler, Lironn de Havenon, Adam Lansberg, Maarten G. |
author_sort | Zhou, Lily W. |
collection | PubMed |
description | BACKGROUND: The objective of the study was to assess the cost‐effectiveness of cilostazol (a selective phosphodiesterase 3 inhibitor) added to aspirin or clopidogrel for secondary stroke prevention in patients with noncardioembolic stroke. METHODS AND RESULTS: A Markov model decision tree was used to examine lifetime costs and quality‐adjusted life years (QALYs) of patients with noncardioembolic stroke treated with either aspirin or clopidogrel or with additional cilostazol 100 mg twice daily. Cohorts were followed until all patients died from competing risks or ischemic or hemorrhagic stroke. Probabilistic sensitivity analysis using Monte Carlo simulation was used to model 10 000 cohorts of 10 000 patients. The addition of cilostazol to aspirin or clopidogrel is strongly cost saving. In all 10 000 simulations, the cilostazol strategy resulted in lower health care costs compared with aspirin or clopidogrel alone (mean $13 488 cost savings per patient; SD, $8087) and resulted in higher QALYs (mean, 0.585 more QALYs per patient lifetime; SD, 0.290). This result remained robust across a variety of sensitivity analyses, varying cost inputs, and treatment effects. At a willingness‐to‐pay threshold of $50 000/QALY, average net monetary benefit from the addition of cilostazol was $42 743 per patient over their lifetime. CONCLUSIONS: Based on the best available data, the addition of cilostazol to aspirin or clopidogrel for secondary prevention following noncardioembolic stroke results in significantly reduced health care costs and a gain in lifetime QALYs. |
format | Online Article Text |
id | pubmed-9238703 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92387032022-06-30 Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke Zhou, Lily W. Kraler, Lironn de Havenon, Adam Lansberg, Maarten G. J Am Heart Assoc Original Research BACKGROUND: The objective of the study was to assess the cost‐effectiveness of cilostazol (a selective phosphodiesterase 3 inhibitor) added to aspirin or clopidogrel for secondary stroke prevention in patients with noncardioembolic stroke. METHODS AND RESULTS: A Markov model decision tree was used to examine lifetime costs and quality‐adjusted life years (QALYs) of patients with noncardioembolic stroke treated with either aspirin or clopidogrel or with additional cilostazol 100 mg twice daily. Cohorts were followed until all patients died from competing risks or ischemic or hemorrhagic stroke. Probabilistic sensitivity analysis using Monte Carlo simulation was used to model 10 000 cohorts of 10 000 patients. The addition of cilostazol to aspirin or clopidogrel is strongly cost saving. In all 10 000 simulations, the cilostazol strategy resulted in lower health care costs compared with aspirin or clopidogrel alone (mean $13 488 cost savings per patient; SD, $8087) and resulted in higher QALYs (mean, 0.585 more QALYs per patient lifetime; SD, 0.290). This result remained robust across a variety of sensitivity analyses, varying cost inputs, and treatment effects. At a willingness‐to‐pay threshold of $50 000/QALY, average net monetary benefit from the addition of cilostazol was $42 743 per patient over their lifetime. CONCLUSIONS: Based on the best available data, the addition of cilostazol to aspirin or clopidogrel for secondary prevention following noncardioembolic stroke results in significantly reduced health care costs and a gain in lifetime QALYs. John Wiley and Sons Inc. 2022-06-03 /pmc/articles/PMC9238703/ /pubmed/35656996 http://dx.doi.org/10.1161/JAHA.121.024992 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Zhou, Lily W. Kraler, Lironn de Havenon, Adam Lansberg, Maarten G. Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke |
title | Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke |
title_full | Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke |
title_fullStr | Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke |
title_full_unstemmed | Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke |
title_short | Cost‐Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke |
title_sort | cost‐effectiveness of cilostazol added to aspirin or clopidogrel for secondary prevention after noncardioembolic stroke |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238703/ https://www.ncbi.nlm.nih.gov/pubmed/35656996 http://dx.doi.org/10.1161/JAHA.121.024992 |
work_keys_str_mv | AT zhoulilyw costeffectivenessofcilostazoladdedtoaspirinorclopidogrelforsecondarypreventionafternoncardioembolicstroke AT kralerlironn costeffectivenessofcilostazoladdedtoaspirinorclopidogrelforsecondarypreventionafternoncardioembolicstroke AT dehavenonadam costeffectivenessofcilostazoladdedtoaspirinorclopidogrelforsecondarypreventionafternoncardioembolicstroke AT lansbergmaarteng costeffectivenessofcilostazoladdedtoaspirinorclopidogrelforsecondarypreventionafternoncardioembolicstroke |