Clopidogrel versus aspirin for the secondary prevention of ischemic stroke and mortality in patients with cardiovascular disease: pharmacoeconomic aspect

Abstract

Aspirin, dipyridamole and clopidogrel are three widely used antithrombotic drugs for the purpose of the secondary prevention of stroke. Based on the results of many clinical studies it has been shown that aspirin and clopidogrel are effective, but both have potentially serious side effects, however, clopidogrel is more expensive than aspirin. The article presents the results of the evaluation of cost-effectiveness of using antiplatelet agents of clopidogrel compared to aspirin in patients with atherosclerosis with ischemic stroke (IS), myocardial infarction (MI) and peripheral artery disease for prevention of acute ischemic stroke and cardiovascular mortality according to the results of CAPRIE randomized clinical research. For pharmacoeconomic analysis such methods as mathematical modeling and decision tree analysis «cost – effectiveness» have been used. The results of CAPRIE randomized clinical trial have shown that the long-term use of clopidogrel in patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of IS, MI, or cardiovascular death. The common safety profile of clopidogrel is the same as for aspirin. The results of pharmacoeconomic analysis indicate that the use of clopidogrel as an antiplatelet agent in patients with cardiovascular disease for prevention of stroke compared to acetylsalicylic acid is more expensive for the payer, but provides additional effectiveness – two surviving lives when treating 1 000 patients.