title: One-year follow-up healthcare costs of patients hospitalized for transient ischemic attack or ischemic stroke and discharged with aspirin plus extended-release dipyridamole or clopidogrel.
abstract: OBJECTIVE
  To examine healthcare costs among patients hospitalized for transient ischemic attack or ischemic stroke (TIA/stroke) and prescribed aspirin plus extended-release dipyridamole (ASA-ERDP) or clopidogrel (CLOPID) within 30 days post-discharge using a retrospective claims database from a large US managed care organization.
  
  
  METHODS
  Adult patients with ≥1 hospitalizations for TIA/stroke between January 2007-July 2009 and ≥1 claims for an oral anti-platelet (OAP) were observed for 1 year before and after the first TIA/stroke hospitalization or until death, whichever came first. Cohorts were defined by the first claim for ASA-ERDP or CLOPID within 30 days post-discharge. A generalized linear model, adjusting for demographics, baseline comorbidities and costs, compared total follow-up costs (medical + pharmacy) between ASA-ERDP and CLOPID patients.
  
  
  RESULTS
  Of 6377 patients (2085 ASA-ERDP; 4292 CLOPID) who met the selection criteria, mean (SD) age was 69 (13) years and 50% were male. Unadjusted mean total follow-up costs were lower for ASA-ERDP than CLOPID ($26,201 vs $30,349; p=0.002), of which average unadjusted medical and pharmacy costs were $22,094 vs $26,062 (p=0.003) and $4107 vs $4288 (p=0.119), respectively. Multivariate modeling indicated that the following were associated with higher total costs (all p<0.05): higher baseline Quan-Charlson comorbidity score, history of atrial fibrillation and myocardial infarction, index stroke hospitalization, death post-discharge, and index CLOPID use. Adjusted mean total follow-up costs for CLOPID were 9% higher than ASA-ERDP (cost ratio: 1.09; p=0.038).
  
  
  CONCLUSIONS
  In this study, compared to CLOPID patients, ASA-ERDP patients were observed to have lower total costs 1 year post-discharge TIA/stroke hospitalization, driven primarily by lower medical costs. Further research into the real-world impact of OAP therapies on clinical and economic outcomes of patients with stroke/TIA is warranted. The findings of this study should be considered within the limitations of an administrative claims analysis, as claims data are collected for the purpose of payment.
authors.affiliation: OptumInsight, Waltham, MA 02451, USA. tanya.burton@optum.com
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Burton
authors.forename: Michael
authors.initials: M
authors.lastname: Lacey
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.forename: Yanni
authors.initials: Y
authors.lastname: Yu
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Monsalvo
authors.forename: Kathy
authors.initials: K
authors.lastname: Lang
authors.forename: Stephen
authors.initials: S
authors.lastname: Sander
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D000077144:Clopidogrel; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy* / Q000191:economics; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin