Ticlopidine compared with aspirin for stroke prevention in high-risk patients is estimated to cost between $31,200 and $55,500 per quality-adjusted life-year gained.
Is ticlopidine cost-effective compared to aspirin for preventing stroke in high-risk patients?
Ticlopidine is a cost-effective alternative to aspirin for stroke prevention in high-risk patients, with an estimated cost of $31,200 to $55,500 per QALY gained.
Effect estimate: $31,200 to $55,500 per QALY gained
BACKGROUND: Ticlopidine, an antiplatelet agent, when compared with aspirin has been found to reduce the risk of stroke in high-risk patients, ie, those with recent transient ischemic attack, reversible ischemic neurological deficit, amaurosis fugax, or minor stroke. Its cost-effectiveness in such use, however, is unknown. METHODS: We developed a model of primary stroke prevention in which a hypothetical cohort of 100 high-risk men and women 65 years of age was assumed to receive either ticlopidine (500 mg daily) or aspirin (1300 mg daily). Using published data, we estimated lifetime incidence of stroke, life expectancy (unadjusted and adjusted for changes in quality of life), and lifetime medical care costs associated with each therapy. RESULTS: Patients who receive ticlopidine would experience two fewer initial strokes per hundred than those treated with aspirin. Life expectancy would be extended by approximately one-half month, and lifetime medical care costs (discounted at 5%) would increase by about 2300. The cost-effectiveness of ticlopidine, compared with aspirin, is estimated to range from 31, 200 to 55, 500 per quality-adjusted life-year gained as the utility of life after nonfatal stroke is assumed to vary from 0. 75 to 0. 95. CONCLUSIONS: Ticlopidine therapy to prevent stroke in high-risk patients is cost-effective by current standards of medical practice.
Oster et al. (1994) studied High risk of stroke (recent TIA, RIND, amaurosis fugax, or minor stroke) (n=100). Ticlopidine vs. Aspirin (1300 mg daily) was evaluated on Cost per quality-adjusted life-year gained ($31,200 to $55,500 per QALY gained). Ticlopidine compared with aspirin for stroke prevention in high-risk patients is estimated to cost between $31,200 and $55,500 per quality-adjusted life-year gained.