TY - JOUR
T1 - Replacing aspirin and warfarin for secondary stroke prevention
T2 - is it worth the costs?
AU - Hankey, Graeme J
PY - 2010/2
Y1 - 2010/2
N2 - PURPOSE OF REVIEW: This review aims to determine whether it is cost-effective to replace aspirin and warfarin with more effective, yet more costly, treatments for secondary stroke prevention.RECENT FINDINGS: For preventing recurrent stroke of arterial origin, clopidogrel and the combination of aspirin and extended-release dipyridamole are equally effective and more effective than aspirin. However, limited data only support their incremental cost-effectiveness, compared with aspirin, in nondisabled patients at high risk of a recurrent ischaemic event (e.g. >20% per year) and when used for short periods (e.g. <2 years). Clopidogrel is also cost-effective for patients who are intolerant of aspirin. For preventing recurrent stroke due to atrial fibrillation, warfarin is cost-effective. Although the combination of clopidogrel and aspirin is more effective than aspirin, it is unlikely to be more cost-effective. Dabigatran is at least as effective and well tolerated as warfarin, but its eventual cost will determine its incremental cost-effectiveness. For atrial fibrillation patients in whom anticoagulation is contraindicated, percutaneous closure of the left atrial appendage may be an alternative strategy. Dronedarone may prove to be a cost-effective adjunct to antithrombotic therapy in patients with atrial fibrillation.SUMMARY: The incremental cost-effectiveness of newer antithrombotic treatments for secondary stroke prevention, compared with aspirin or warfarin, remains to be established.
AB - PURPOSE OF REVIEW: This review aims to determine whether it is cost-effective to replace aspirin and warfarin with more effective, yet more costly, treatments for secondary stroke prevention.RECENT FINDINGS: For preventing recurrent stroke of arterial origin, clopidogrel and the combination of aspirin and extended-release dipyridamole are equally effective and more effective than aspirin. However, limited data only support their incremental cost-effectiveness, compared with aspirin, in nondisabled patients at high risk of a recurrent ischaemic event (e.g. >20% per year) and when used for short periods (e.g. <2 years). Clopidogrel is also cost-effective for patients who are intolerant of aspirin. For preventing recurrent stroke due to atrial fibrillation, warfarin is cost-effective. Although the combination of clopidogrel and aspirin is more effective than aspirin, it is unlikely to be more cost-effective. Dabigatran is at least as effective and well tolerated as warfarin, but its eventual cost will determine its incremental cost-effectiveness. For atrial fibrillation patients in whom anticoagulation is contraindicated, percutaneous closure of the left atrial appendage may be an alternative strategy. Dronedarone may prove to be a cost-effective adjunct to antithrombotic therapy in patients with atrial fibrillation.SUMMARY: The incremental cost-effectiveness of newer antithrombotic treatments for secondary stroke prevention, compared with aspirin or warfarin, remains to be established.
KW - Anti-Inflammatory Agents, Non-Steroidal/economics
KW - Anticoagulants/economics
KW - Aspirin/economics
KW - Benzimidazoles/economics
KW - Cost-Benefit Analysis
KW - Dabigatran
KW - Humans
KW - Platelet Aggregation Inhibitors/economics
KW - Pyridines/economics
KW - Stroke/drug therapy
KW - Ticlopidine/analogs & derivatives
KW - Warfarin/economics
U2 - 10.1097/WCO.0b013e328334e67b
DO - 10.1097/WCO.0b013e328334e67b
M3 - Review article
C2 - 19949330
VL - 23
SP - 65
EP - 72
JO - Current Opinion in Neurology
JF - Current Opinion in Neurology
SN - 1350-7540
IS - 1
ER -