Social Security Perspective Research Articles

ANÁLISIS DEL DERECHO HUMANO DE LA SEGURIDAD SOCIAL DESDE EL CONVENIO BILATERAL VIGENTE ENTRE MÉXICO Y ESPAÑA

The article analyzes the Social Security Agreement between Mexico and the Kingdom of Spain of 1994 from the perspective of social security as a human right. In this sense, it is divided into 5 sections: The first one specifies the way in which social security is materialized as a human right in Mexico; the second presents an outline of the bilateral relationship between Mexico and Spain through their bilateral agreements; In the third and fourth, the bilateral agreement is properly analyzed: the regimes and types of labor relations to which the agreement applies, as well as benefits and their materialization. Finally, the fifth section contributes to reflecting on the importance of this agreement -as part of International Social Security Law- for the justiciability of social security as a human right

Cost-Effectiveness of Venetoclax and Rituximab Combination Therapy in Relapsed/Refractory Chronic Lymphocytic Leukemia (CLL) in Argentina

OBJETIVE: To estimate the cost- effectiveness of Venetoclax + Rituximab (VEN + R) versus ibrutinib in the treatment of Relapsed/Refractory (R/R) Chronic Lymphocytic Leukaemia (CLL), in Argentina from the Social Security perspective." METHODS: A three-state partitioned survival model (including pre-progression, post-progression and death) developed in accordance with the NICE Guide to the Methods of Technology Appraisal and the ISPOR decision modelling guidelines was adapted to Argentina setting. Population inputs are derived from the MURANO trial. Efficacy and safety data for treatments in R/R CLL were obtained from the literature. The cost of medication was based on country level drug prices. Costs of resources used for routine medical attention and the management of adverse events were based on tariffs from social security system of Argentina. Costs were expressed in US dollars ($) (exchange rate 1$ = 37.10 AR$, November 2018). A 30-year time horizon and the Social Security's payer's perspective were assumed. Costs and health outcomes were discounted at 5%. Deterministic and probabilistic sensitivity analyses (PAS) were performed. RESULTS: Over a 30-year time horizon, VEN + R regimen generates a significantly lower total treatment cost in comparison to Ibrutinib (- US dollars ($) 312.679,37). In QALYs the result is higher in VEN + R related to the comparator (5.83 vs. 4.18). These show that VEN + R is a dominant treatment strategy over Ibutrinib in patients with R/R CLL. The univariate sensitivity and scenario analysis confirm the robustness of this result. Likewise, the probabilistic sensitivity analysis shows that there is a 100% probability that VEN + R is a cost-effective strategy against Ibrutinib. CONCLUSIONS: This study shows that in Argentina, VEN+R would be dominant treatment option (better results and lower costs) compared with ibrutinib in R/R CLL patients. Disclosures Elgart: 3eff: Consultancy. Glancszpigel:3eff: Employment. Kanevsky:Abbvie: Employment. Godar:Abbvie: Employment. Touliet:Abbvie: Employment. Albaytero:3eff: Employment.

Cost-Effectiveness of Secukinumab Versus Other Biologics in the Treatment of Psoriatic Arthritis: An Argentinean Perspective

ObjectivePsoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. This study assessed the cost-effectiveness of secukinumab, an interleukin-17A inhibitor, versus other biologics in PsA from the Argentinean social security perspective. MethodsA semi-Markov model evaluated subcutaneous (sc) treatment with secukinumab 150 mg and 300 mg against other sc treatments such as adalimumab, certolizumab pegol, etanercept, golimumab, ustekinumab, and intravenous treatment infliximab in biologic-naïve (with or without moderate to severe psoriasis) and biologic-experienced PsA patients over a lifetime horizon. Response to treatments was determined using the PsA Response Criteria (PsARC) at 12 weeks. Model inputs were derived from randomized controlled trials, network meta-analyses, published literature, and other Argentinean sources. Model outcomes included quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios. Sensitivity analyses and alternative scenarios with a higher cost option were also conducted. ResultsAmong biologic-naïve PsA patients without psoriasis, secukinumab 150 mg provided the highest QALYs (7.18) versus all sc biologics at the lowest cost ($3 755 678 Argentine peso), thus dominating them. Among biologic-naïve PsA patients with psoriasis and biologic-experienced PsA patients, secukinumab 300 mg provided highest QALYs (6.99 and 7.53, respectively), dominated infliximab, and was cost-effective versus other sc biologics. Deterministic sensitivity analyses indicated sensitivity of results to variation in PsARC rates, drug acquisition costs, Health Assessment Questionnaire change, and utilities. A probabilistic sensitivity analysis showed maximum net monetary benefits with both secukinumab doses. Results from an alternative scenario analysis were similar to base-case analysis. ConclusionsFor both biologic-naïve and experienced PsA patients, secukinumab is either a dominant or cost-effective treatment option compared with other biologics in Argentina.

Optimization of inventory policies of food grain distribution stage in public distribution system

Purpose The purpose of this paper is to model the distribution stage of the public distribution system (PDS) and optimize the inventory policy during this stage of the PDS to address some of the inefficiencies present in the system. This study models this supply chain as a multistage supply chain consisting of storage depots, issue centers, fair price shops and card holders. Design/methodology/approach A two-stage modeling approach is used to model the distribution stage in the PDS. In the first stage, the authors developed a simulation model for periodic review-based stock policy with appropriate assumptions. This helped minimize the total supply chain cost (TSCC). The TSCC consists of three cost elements, namely, ordering cost, holding cost and shortage cost. These three cost elements, in turn, depend on inventory policy parameters, such as review periods and base stock levels, at various echelons. In the second stage, a Genetic Algorithm based optimization approach was used. Findings A set of optimal policy parameters was identified. It is observed that base stock levels at issue centers are higher as compared to those in the FPS and the TSCC is less in scenario, when backorder cost is equal to the holding cost. Practical implications Present study will be useful to policy makers in improving PDS performance. This optimization of inventory policies helps actors in the PDS supply chain to choose appropriate policy parameters in the present inventory policy so as to reduce the overall distribution cost. Originality/value Unlike the previous researchers who examined the PDS from the social security perspective and tried to address specific problems to improve functioning of the PDS, this study looked at the problem as a supply chain-related problem and optimized the inventory parameters in one of the subsets of the PDS supply chain.

PCN113 - EVALUATING THE ECONOMIC IMPACT OF NOVEL AGENTS FOR TREATING MULTIPLE MYELOMA

The objective of this study was to map the current therapeutic pathway in order to estimate MM disease management cost and investigate the economic implications for EOPYY from the introduction of novel agents in clinical practice. An expert panel consisting of special hematologists from public hospitals was asked to document patient distribution within the different treatment lines, regimens and resource use and extract corresponding estimations for the next 2-3 years, based on the reallocation of patients to treatment lines due to the introduction of newer regimens. Cost analysis was carried out from the social security perspective based on national reimbursed prices and DRGs tariffs. Approximately 400-500 patients are diagnosed each year in Greece, within a total estimated of 1,600 to 2,000 patients. Amongst those submitted to anti-myeloma treatment, about 27% resides in a different prefecture than the one being treated. Annual burden was estimated at €77.7 mln (€48,536/patient) due to current treatment regimens vs. €95 mln (€59,318/patient) related to the introduction of novel regimens in the near future, reaching at 8.5% of the public expenditure on all types of cancer. Approximately 87.5% of the annual cost was related to drugs, followed by prophylaxis and optimum supportive care cost (about 6%). Among patients in the line referring to the first relapse following a regimen containing a proteasome inhibitor, about 2/3 is estimated to receive (in the near future) DRd or KRd and 9.2% IRd (orally administered). The respective line is estimated to be the most costly (€24.5 mln/year) due to increased use of novel agents. However, annual cost of IRd (€2.5 mln/year) contributes less than 10% to overall cost of this line. Despite novel agents’ high cost, emphasis needs to be placed on measuring the value of care, taking into consideration improved outcomes correlated to novel regimens.

PCN78 - EVALUATING THE ECONOMIC CONSEQUENCES OF NOVEL AGENTS FOR TREATING HODGKIN LYMPHOMA IN GREECE

The objective of this study was to map the current treatment algorithm in order to estimate Hodgkin’s Lymphoma (HL) disease management cost and calculate the economic burden for SSF from the introduction of novel agents in clinical practice. An expert panel consisting of seven special hematologists from public hospitals and academia was asked to document patient distribution within the different treatment lines, various therapeutic options (regiments: ABVD; BEACOPP; ChlVPP; GND; GN; GDP; IGEV; ESHAP; C-MOPP; DICE; Mini –BEAM, brentuximab vedotin; nivolumab, radiotherapy, auto and allo SCT) and resource use. Cost analysis was carried out from the social security perspective based on national reimbursed prices and DRGs tariffs (2018). Approximately, 45% of those submitted to anti-HL treatment related to first line, while the rest were almost equally classified to second (29%) and third line (25%). Amongst HL patients, 39% resides in a different prefecture than the one being treated. Between those prior submitted to auto- SCT, 43% received an antibody-drug conjugate as consolidation after the transplantation (mean 15 cycles). Economic burden was estimated at ∼€48,200/patient (on average for all treatment lines), almost threefold country’s per capita GDP. More than 81% of total cost was related to drugs, followed by drugs’ administration & prophylaxis / optimum supportive care (6.4%), and cost of diagnostic and follow up laboratory exams (5.2%). Third line (relapsed stages) was estimated to be the most costly due to increased and long term use of expensive novel treatments. Although novel treatments increased cost, emphasis needs to be placed on estimating the value of care, taking into consideration improved outcomes (in terms of overall survival and avoidable exposure to subsequent chemo toxicities) correlated to novel regimens.

The intersection of social protection and mobilities: a move towards a ‘Practical Utopia’ research agenda

Currently, a number of contributions in mobility studies are looking for fruitful intersections with other ‘adjacent’ approaches . In this spirit, our theoretical paper argues to study one particular aspect: the intersection of social protection and mobilities. Currently, the provision of social services in the ‘West’ is strongly entrenched within nation-state logics, which assume that clients’ immobility is a precondition of service delivery and that national citizenship is the desirable conditionality of gaining social rights. To overcome such a wide-spread conflation of social security with state security, we introduce the heuristic concept ‘social protection’. It allows social security to be imagined beyond a state-centric perspective and avoids the pitfalls of either a citizenship or a migration approach by taking on a mobility perspective. Thus, for scholars anchored in mobility studies we propose how to develop a social security perspective in a progressive way. For readers from other areas, e.g. citizenship, migration or social policy, we will show how a mobility perspective enriched by a No Border approach can overcome a narrow Western, statist and static perspective on social security. Our goal is to conceptually open up what we call a ‘practical utopia’ research agenda, one that expands our political horizons for future and present socialities.

Overall Urban–Rural Coordination Measures—A Case Study in Sichuan Province, China

Focusing on urban–rural development issues, this paper analyzes the necessity of coordinated development between the narrowing gap and integral development. An overall urban– rural development dynamic model aimed at two major objectives is pointed out. A principal component analysis (PCA)—Grey Entropy measurement model is proposed to evaluate urban–rural coordination from economic development, social security, public services, and environmental quality perspectives. In this model, principal component analysis (PCA) was used to extract the components that explained overall urban–rural coordination. This model was then combined with Grey Entropy to measure the level of urban–rural development coordination. By establishing a scientific measurement model, the coordination value of the rural and urban areas was effectively calculated from a comprehensive perspective, including subsystems and static and dynamic coordination values. Finally, the model was applied to Sichuan Province as an example to show its effectiveness in measuring urban–rural coordination.

Asthma boundaries in a social security perspective

Introduction: Patients in Poland, including asthmatics are beneficiaries of social security system in case of severe disease exacerbation. Usually sick leave due to uncontrolled asthma is enough to get better and come back to regular life, however some patients with permanent severe symptoms require invalidity pension to secure their social rights and life quality. Nowadays, the social security system is overloaded due to insufficiency of income versus expenditures, and asthma as disease might represent a significant part of this costs due to its prevalence. Objective of the study: In this article we have analysed trends in asthma management at the social insurance financial perspective, comparing the asthma social security costs to the overall social security system expenses. Material and methods: The study and analyses are based on the Polish Social Security Institution (ZUS) data publicised in years 2010-2014. Results: In year 2014 total ZUS and employers spendings on social benefits to ill patients were calculated at 32,5 billion of Polish Zloty. Respectively all respiratory system diseases social security costs accounted 2,2 billion of Polish Zloty, of which estimated asthma (J-45) 64 million of Polish Zloty, and status asthmatics (J-46) 580 thousands of Polish Zloty. Conclusions: Asthma social security costs represent 0,21% of all diseases social security costs and less than 3% of all respiratory diseases social security costs. Despite variability of the costs over years 2012-2014, there are no significant negative trends of asthma costs into the social security system.

AN EVALUATION OF THE CONSOLIDATED NATIONAL SOCIAL SECURITY BILL FOR LESOTHO: PART I

This article is about social security, which, in turn, is a subset of social policy. ‘Social policy’ is a term that is applied to many areas of policy, usually within a governmental or political setting (such as social services). This article critically evaluates the proposed Consolidated National Social Security Bill for Lesotho. It examines the general background to the proposed national social security scheme; the legislative framework for the proposed scheme; the governance and institutional framework of the scheme as well as the establishment of insurance funds and the financing sources of various funds. The evaluation is undertaken through the lens of social security perspectives and policy considerations.

Medical Health Resources Allocation in Liaoning Province Based on System Dynamics

On the perspective of social security and the complex system theory, we discuss the choice of the path to the sustainable development of medical health resources in Liaoning province, and then provide theory support for perfecting medical and health resources in Liaoning province by building a system dynamics model on simulation software AnyLogic6.4.1 platform.

PIN48 Cost-Efectiveness Analysis of Darunavir Versus Atazanavir, Each in Combination With Emtricitabine and Tenofovir, for the Management of Naive Anti-Retroviral HIV Infected Patients, Under the Belgian Social Security Perspective

PIN48 Cost-Efectiveness Analysis of Darunavir Versus Atazanavir, Each in Combination With Emtricitabine and Tenofovir, for the Management of Naive Anti-Retroviral HIV Infected Patients, Under the Belgian Social Security Perspective

A budget impact analysis comparing a Hydrofiber®; dressing to an alginate dressing in managing exuding venous leg ulcers in France

An Excel model was developed to compare total costs (including primary and secondary dressings only) of Hydrofiber(®) ; dressing (2010 branded price) versus an alginate dressing (generic or branded price) in managing exuding venous leg ulcers considering mean wear time and mean duration of exudate management phase, from the French Social Security perspective over 5 years (2011-2015). Budget impact (based on prevalence of venous leg ulcers in France) was estimated as the difference between scenario 1 (Hydrofiber(®) ; versus alginate dressing usage proportion increasing slightly per year) and Scenario2 (proportion remaining at 2010 levels). Annual costs and net savings per patient for the dressings were calculated in analyses 1 and 2. Analysis 1 (28-day mean exudate management phase for both Hydrofiber(®) ; and alginate dressing groups): total costs 66·82€ Hydrofiber(®) ;, 70·08€ generic alginate, 77·0€ branded alginate; net savings 3·26€ and 10·18€ for Hydrofiber(®) ; versus generic and branded alginate. Analysis 2 (mean exudate management phase of 22·2 versus 28 days for Hydrofiber(®) ; versus alginate): total costs 52·92€, 70·08€ and 77·0€, and net savings 17·10€ and 24·02€, accordingly. Total cost savings (budget impact scenario 1 minus scenario 2): Analysis 1 - 223 107€ and 696 304€ for Hydrofiber(®) ; versus generic and branded alginate dressings, respectively; Analysis 2 - 1 169 845€ and 1 643 042€ accordingly. Sensitivity analyses indicated that results are reliable. This conservative analysis shows that effective exudate management using Hydrofiber(®) ; dressing can produce sizeable cost savings.

P1-10-06: Economic Analysis of Chemotherapy Costs for Adjuvant Therapy in Breast Cancer in France.

Abstract Background: Total costs of adjuvant chemotherapy can be estimated using different perspectives. To date, only few studies are available in France and only few of these studies have incorporated all the relevant cost items. Indeed the total cost of adjuvant chemotherapy for breast cancer should include not only the drug costs and their administration but also supportive care, transportation and part of the work absenteeism, because all these costs are borne by the French social security. The study objective was to estimate the total costs of adjuvant chemotherapy in France using two different perspectives: the French social security and society. Methods: We conducted a retrospective study to calculate the total cost of first line adjuvant chemotherapy for breast cancer in France. We developed an electronic CRF to collect clinical data, chemotherapy drug details, side effects and personal data such as the type of transportation from home to hospital for chemotherapy treatments and duration of work absenteeism. We added the cost of medical consultations, radiology and biology. We also calculated the exact cost of paramedical time and material. All data were collected after patient's acceptance from clinical records and by phone. Medical resource data were collected from patients’ files for which data were recorded in February 2010 in Tenon hospital (Paris). Unit costs were collected from the French medical insurance database, and other public sources such as national statistics and the technical agency for hospitalization information. Results: We collected data from 30 patients who had adjuvant chemotherapy for breast cancer. Median age was 57.7 years and 37.9% of patients had a regular work. Using the social security perspective, the mean cost (+/− SD) for pre chemotherapy exams and management (biology, oncologist consultation, implantable port system) was €320 +/−€32. For each chemotherapy cycle, the costs of chemotherapy drugs, preventive medications and chemotherapy administration were €1267 +/− €1424. The cost of chemotherapy adverse events was €405 +/− €829 and €39 +/− €28 for usual monitoring of chemotherapy (biology tests and medical consultations). Transportation costs were estimated at €11 +/− €12 and sick leave payments at €445 +/− €521. The mean total cost per cycle was €1806 +/− €1226 per chemotherapy cycle and €12724 +/− €8426 for the whole adjuvant chemotherapy regimen. Using a broader societal perspective, the total cost of chemotherapy was €14668 +/− €9707 per patient, as it included the full cost of lost productivity due to work absenteeism. Conclusion: We reported the first cost analysis of adjuvant chemotherapy for breast cancer in France using two different perspectives (the French social security and the society). Using the social security perspective, chemotherapy drugs and their administration accounted for 70% of the total cost of chemotherapy against 60% when using the societal perspective. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-10-06.

Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil

Vaccination of adults aged 60 years and older against Streptococcus pneumonia is not recommended in Brazil. The 23-valent polysaccharide pneumococcal vaccine (PPV23) is only available for institutionalized persons or with underlying diseases despite the substantial medical and economic burden related to pneumococcal infections in adults over than 59 years. The study aimed at evaluating the cost effectiveness of implementing a large PPV program in this population.This analysis was performed using a static decision tree model. Demographic and epidemiological data were obtained from Brazilian official sources and international literature. Economic data were obtained from a study performed in 2007 in a public and a private hospital located in Sao Paulo. Vaccination was assumed to protect for 5 years with 60% effectiveness against bacteremic pneumococcal pneumonia (BPP) and 21% effectiveness against non bacteremic pneumococcal pneumonia (NBPP). Deterministic and sensitivity analyses were performed.The pneumococcal polysaccharide vaccination saved 5,218 life year gained (LYG). The vaccination program was found to be cost effective in the social security and public health care perspectives with a mean incremental cost-effectiveness ratio of R$10,887 and R$8,281 per LYG respectively. Results were sensitive to the vaccine effectiveness against NBPP, the incidence and case-fatality rate of NBPP. From a societal perspective, PPV23 program for adults 60 and older was found to be cost-saving.Pneumococcal polysaccharide vaccination is clinically and economically favored over the present vaccination strategy, in which persons aged over 59 years in Sao Paulo, have not been vaccinated.

Imatinib versus interferon-α (IFN-α) plus ara-c for patients with newly diagnosed chronic-phase (CP) chronic myeloid leukemia (CML) from the Mexican Institute of Social Security (IMSS) perspective: 72 months number needed to treat (NNT) to achieve a complete cytogenetic response (CCyR)

17542 Background: Imatinib mesylate(IM) is the standard of care for CML because it has demonstrated high and durable responses as well as survival advantage over IFN based therapy (Hochhaus, Blood (ASH Annual Meeting Abstracts) 2007.110: 25). Reed et al, estimated the survival for a newly diagnosed CP-CML patient treated with imatinib was 19.07 years vs. 9.09 years with IFN/Ara-C (Reed, Pharmacoeconomics in press). IM has been included in the Mexican National Basic Formulary as first-line agent and as second-line agent after IFN. CCyR has been established as an effective measure for treatment efficacy in CML, furthermore CCyR is associated to prolonged survival on CML patients. In this study, the NNT approach was used to compared IM with IFN/ Ara-C from the Mexican public healthcare system's perspective. Methods: NNT represents the number of patients that need to be treated with a new intervention in order to achieve one additional event, and is a powerful approach that can be used to make sense of numerical results from clinical trials. The NNT was calculated by the inverse of CCyR at 72 months. A key requirement for an NNT analysis is that all outcomes must be considered over similar time periods. The rates of CCyR at 72 months for IM and IFN/Ara-C as first line treatment for CML-CP were obtained from the International Randomized Interferon vs. STI571 (IRIS) Study update. Results: The 72-month CCyR rate for IM was 82% vs. 12% for IFN/Ara-C. The NNT for IM was 15 patient versus 8.33 for IFN plus Ara-C. For every 1.15 patients treated with IM, 1 patient will achieve a CCyR by 72 months. However, in order to achieve a CCyR with IFN plus Ara-C by 72 months, 7.18 more patients need to be treated, a 7.24- fold difference in NNT to achieve a CCyR, favoring IM. Conclusions: The NNT to achieve a CCyR by 72 months with IM is much lower than that with IFN plus Ara-C in newly-diagnosed CP-CML patients. Further analysis including the total cost of treatment (drug cost and cost to treat adverse events) from Mexico will be conducted to assess the cost-effectiveness comparing IM with IFN/Ara-C in CML-CP patients from the IMSS perspective. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Novartis Novartis

China’s Urban-Rural Gap: An Analysis Based on Capability

The current urban-rural gap in China is caused by several factors and embodied in various respects. This paper analyzes the relevant factors from the perspective of capability, including income, education, health, employment opportunity and social security. Only by improving the capabiliity of the rural residents, can the problem of the ever-widening gap between urban and rural areas be really solved.

Fostering Within-Family Human-Capital Investment: An Intragenerational Insurance Perspective of Social Security

We develop a general equilibrium stochastic OLG model with heterogenous households. Households dier with respect to their productivity. Productivity depends stochastically on parents’ unobservable investment in their child’s human capital and an aggregate productivity shock. We introduce a PAYG social security system that conditions benefits on the aggregate wage sum and on the wage of one’s child. We analyze the eects of such a social security system on the endogenous distribution of human capital and compare it to real world systems which typically do not condition benefits on the wages of one’s children. We decompose the eects of social

Costs associated with persistent allergic rhinitis are reduced by levocetirizine

Allergic rhinitis was recently classified by the ARIA guidelines as persistent or intermittent. Levocetirizine was shown to improve symptoms and health-related quality of life of patients with persistent allergic rhinitis in the XPERT study, a 6-month randomized double blind placebo-controlled trial. To assess the total costs of persistent allergic rhinitis, and the effect of long-term treatment with levocetirizine on these costs from several perspectives (societal, social security system, and employers). Direct medical cost parameters (medications, physician visits and hospitalizations) and time lost parameters (workdays and Usual Daily Activities (UDA) lost) related to persistent allergic rhinitis and its comorbidities (asthma, sinusitis, otitis and upper respiratory infection) were measured. A cost analysis was performed using 2002 French costing data. From a societal perspective, the total cost of persistent allergic rhinitis without long-term treatment was estimated at 355.06/patient/month. From a social security perspective, levocetirizine treatment yielded an additional cost of 2.78/patient/month, compared to no-treatment. However, levocetirizine reduced the total cost of persistent allergic rhinitis and its comorbidities by 152.93/patient/month from a societal perspective and by 64.70/patient/month from an employer perspective. Most gains resulted from a decrease in the lost workdays and UDA in the levocetirizine group. The cost of persistent allergic rhinitis is substantial. Treatment with levocetirizine reduces the cost of persistent allergic rhinitis and its comorbidities to the society by 152.93/patient/month while improving symptoms and health-related quality of life.

Economic assessment of the secondary prevention of ischaemic stroke with dipyridamole plus aspirin (Aggrenox/Asasantin) in France.

To assess the cost effectiveness of aspirin 25 mg plus dipyridamole 200 mg twice daily in the secondary prevention of ischaemic stroke, according to the French social security perspective, using efficacy data from the second European Stroke Prevention Study (ESPS-2). The ESPS-2 was a double-blind, placebo-controlled clinical trial which assessed the efficacy of four secondary prevention strategies: (i) placebo; (ii) aspirin (acetylsalicylic acid) 25 mg twice daily; (iii) dipyridamole 200 mg twice daily; and (iv) aspirin 25 mg plus dipyridamole 200 mg twice daily. We performed a cost-effectiveness analysis with Monte Carlo simulations to compute confidence intervals. We combined data from various sources including the Dijon Stroke Registry, Institut National de la Statistique et des Etudes Economiques, Etude du Coût de l'Infarctus Cérébral (Study of the Cost of Cerebral Infarction [ECIC]) study and the ESPS-2 trial. According to our findings, a preventive strategy with aspirin 25 mg plus dipyridamole 200 mg twice daily is associated with net benefits per avoided stroke recurrence amounting to USD 23,932 (95% CI -USD 32,609, USD 35,772) compared with aspirin 25 mg twice daily alone, and USD 31,555 (95% CI USD 4921, USD 74,515) compared with dipyridamole alone (1997 values). Sensitivity analysis demonstrated that dipyridamole plus aspirin was still cost effective when the average cost of adverse effects per episode (ignored in the original estimation of the cost-effectiveness ratios due to a lack of data) was assumed to be USD 8600 (50,000 French francs); this cost is unlikely as most of the adverse effects associated with aspirin plus dipyridamole are only slight to moderate in severity. In the secondary prevention of stroke in France, this study suggests, given its underlying assumptions and data, that aspirin 25 mg plus dipyridamole 200 mg twice daily is likely to be a cost-effective strategy from the social security perspective, when compared with other relevant strategies that were evaluated in the ESPS-2 trial.