title: Managed care considerations.
abstract: Stroke is the third leading cause of death in the United States and among the most costly diseases. Most strokes are categorized as ischemic, and 10% to 15% are preceded by a transient ischemic attack (TIA). Stroke survivors suffer levels of disability and handicap that range from mild to very severe, and they rarely make a complete recovery. Initial stroke patients are at considerable risk for recurrent stroke, which can compound a patient's impairment and associated costs. This article discusses the burden of stroke on patients and caregivers, the risk of stroke recurrence, and the pharmacoeconomics of antiplatelet therapy. Studies show that effective secondary prevention such as antiplatelet therapy can improve clinical outcomes in patients who have experienced TIA or prior stroke. Recently updated guidelines for secondary stroke prevention from the American Heart Association/American Stroke Association recommend administering antiplatelet agents rather than anticoagulants for patients who experienced an ischemic noncardioembolic stroke or TIA to reduce the risk of stroke or other cardiovascular events. The guidelines state that aspirin (ASA), ASA + extended-release dipyridamole (DP), and clopidogrel are acceptable initial treatment options for these patients. A recent pharmacoeconomic analysis of all 3 therapies concluded that ASA and ASA + DP offer cost-effective secondary prevention for patients who have suffered a mild initial stroke. Understanding the role of antiplatelet therapy in secondary prevention can help the managed care community optimize clinical and economic outcomes, thereby reducing the overall burden of cerebrovascular disease.
authors.affiliation: SelectHealth, 9502 Carriage Chase Ln, Sandy, UT 04092, USA. jeffrey.dunn@selecthealth.org
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Dunn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D017281:Cost of Illness; D017850:Economics, Pharmaceutical; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011315:Preventive Medicine; D012008:Recurrence; D018570:Risk Assessment; D020521:Stroke / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology