Pharmacoeconomic evaluation of clopidogrel versus aspirin for secondary prevention of ischemic stroke
- VernacularTitle:氯吡格雷对比阿司匹林用于缺血性脑卒中二级预防的药物经济学评价
- Author:
Yitian LANG
1
;
Chunli ZHU
1
;
Wenqi TAO
1
;
Yahui LIAO
1
;
Chi ZHANG
2
;
Xiaoyan LIU
1
;
Bin WU
2
Author Information
1. Dept. of Pharmacy，Huangpu Branch，Shanghai Ninth People’s Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200011，China
2. Dept. of Pharmacy，Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine，Shanghai 200127，China
- Publication Type:Journal Article
- Keywords:
clopidogrel;
aspirin;
antiplatelet agents;
ischemic stroke;
secondary prevention;
pharmacoeconomic evaluation
- From:
China Pharmacy
2023;34(7):837-843
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the cost-effectiveness of clopidogrel versus aspirin monotherapy regimens for secondary prevention of ischemic stroke and to provide economic evidence and reference for clinical medication and decision-making. METHODS Based on the CAPRIE trial， a Markov model was constructed； the probabilities of risk events， health utility values， and costs of risk event management were obtained from relevant literature. The cycle length was 6 months， and the time horizon was 10 years. A discount rate of 5% per year was applied. The primary outcomes were total costs， quality-adjusted life-years （QALYs）， and incremental cost-effectiveness ratio （ICER）. Cost-utility analysis was performed for above 2 regimens by using TreeAge Pro software. The one-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were conducted to validate the robustness of the analyses. RESULTS Compared with the aspirin regimen （325 mg/d of CAPRIE trial dose）， the ICER values of clopidogrel regimen for secondary stroke prevention for 10 years， 20 years and 30 years were 4 284.06， 4 201.20 and 3 986.78 yuan/QALY， respectively， which were E-mail：liuxiaoyanrj@sjtu.edu.cn all less than the willing-to-pay （WTP） threshold of one time 。 China’s per capita gross domestic product （GDP） in 2021. E-mail：scilwsjtu-wb@yahoo.com Compared with the aspirin regimen （clinically recommended dose in China， 100 mg/d）， the ICER values of clopidogrel regimen for stroke secondary prevention for 10 years， 20 years and 30 years were 58 238.27， 42 164.72 and 36 164.77 yuan/QALY， respectively， which were all less than WTP threshold. When comparing with aspirin regimen of 325 mg/d， results of one-way sensitivity analysis showed that the cost of clopidogrel and aspirin， probability of the first recurrence of ischemic stroke were sensitive factors of model. Results of probabilistic sensitivity analysis showed that when WTP was set at one time GDP per capita in China in 2021， clopidogrel had a probability of being cost- effective of about 66.5%. Results of scenario analysis showed that neither changing the time horizon to 10， 20 or 30 years nor using different doses of aspirin （50， 100， 150， 200 or 250 mg/d） would not alter any conclusions. CONCLUSIONS Compared with aspirin monotherapy， clopidogrel monotherapy is more cost-effective for secondary prevention of ischemic stroke.
