Abstract TP81: Cost Effectiveness Of Cilostazol Added To Aspirin Or Plavix For Secondary Stroke Prevention Following Non-cardioembolic Stroke

Abstract

Background: The objective of the study is to compare the cost-effectiveness of cilostazol (a selective phosphodiesterase 3 inhibitor) added to aspirin (ASA) or Plavix in patients with non-cardioembolic stroke for secondary stroke prevention. Methods: A Markov model decision tree was used to examine lifetime costs and Quality Adjusted Life Years (QALYs) of patients with non-cardioembolic stroke treated with either single antiplatelet (ASA or Plavix) or with additional cilostazol 100 mg twice daily. Cohorts were followed until all patients died from competing risks, ischemic or hemorrhagic stroke. Input parameters are shown in Table 1. Probabilistic sensitivity analysis using Monte-Carlo simulation was used to model 10 000 cohorts of 10 000 patients. Results: The addition of cilostazol to ASA or Plavix is strongly cost saving (Figure 1). In all 10 000 simulations, the cilostazol strategy resulted in lower health care costs compared to ASA or Plavix alone (mean $14 450 lower per patient, SD $8 466 USD). In 9 998/10 000 simulations, the cilostazol strategy resulted in higher QALYs (mean 0.6016 QALY per patient, SD 0.0704). This result remained robust across a variety of sensitivity analyses varying cost inputs and treatment effects. Conclusion: Based on best available data, the addition of cilostazol to ASA or Plavix for secondary prevention results in significantly reduced healthcare costs and higher lifetime QALYs for patients with non-cardioembolic stroke. Confirmation with high quality data from a randomized trial including a high proportion of non-Asian patients is needed to increase generalizability.