Open AccessCost‐Effectiveness of Clopidogrel‐Aspirin Versus Aspirin Alone for Acute Transient Ischemic Attack and Minor Stroke
Author(s) -
Pan Yuesong,
Wang Anxin,
Liu Gaifen,
Zhao Xingquan,
Meng Xia,
Zhao Kun,
Liu Liping,
Wang Chunxue,
Johnston S. Claiborne,
Wang Yilong,
Wang Yongjun
Publication year - 2014
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.114.000912
Subject(s) - medicine , clopidogrel , aspirin , minor stroke , stroke (engine) , regimen , quality adjusted life year , cost effectiveness , platelet aggregation inhibitor , anesthesia , cardiology , risk analysis (engineering) , mechanical engineering , stenosis , engineering
Background Treatment with the combination of clopidogrel and aspirin taken soon after a transient ischemic attack ( TIA ) or minor stroke was shown to reduce the 90‐day risk of stroke in a large trial in China, but the cost‐effectiveness is unknown. This study sought to estimate the cost‐effectiveness of the clopidogrel‐aspirin regimen for acute TIA or minor stroke. Methods and Results A Markov model was created to determine the cost‐effectiveness of treatment of acute TIA or minor stroke patients with clopidogrel‐aspirin compared with aspirin alone. Inputs for the model were obtained from clinical trial data, claims databases, and the published literature. The main outcome measure was cost per quality‐adjusted life‐years ( QALY s) gained. One‐way and multivariable probabilistic sensitivity analyses were performed to test the robustness of the findings. Compared with aspirin alone, clopidogrel‐aspirin resulted in a lifetime gain of 0.037 QALY s at an additional cost of CNY 1250 ( US $ 192), yielding an incremental cost‐effectiveness ratio of CNY 33 800 ( US $ 5200) per QALY gained. Probabilistic sensitivity analysis showed that clopidogrel‐aspirin therapy was more cost‐effective in 95.7% of the simulations at a willingness‐to‐pay threshold recommended by the World Health Organization of CNY 105 000 ( US $ 16 200) per QALY . Conclusions Early 90‐day clopidogrel‐aspirin regimen for acute TIA or minor stroke is highly cost‐effective in China. Although clopidogrel is generic, Plavix is brand in China. If Plavix were generic, treatment with clopidogrel‐aspirin would have been cost saving.