title: Cost-effectiveness of clopidogrel-aspirin versus aspirin alone for acute transient ischemic attack and minor stroke.
abstract: BACKGROUND
  Treatment with the combination of clopidogrel and aspirin taken soon after a transient ischemic attack (TIA) or minor stroke was shown to reduce the 90-day risk of stroke in a large trial in China, but the cost-effectiveness is unknown. This study sought to estimate the cost-effectiveness of the clopidogrel-aspirin regimen for acute TIA or minor stroke.
  
  
  RESULTS
  A Markov model was created to determine the cost-effectiveness of treatment of acute TIA or minor stroke patients with clopidogrel-aspirin compared with aspirin alone. Inputs for the model were obtained from clinical trial data, claims databases, and the published literature. The main outcome measure was cost per quality-adjusted life-years (QALYs) gained. One-way and multivariable probabilistic sensitivity analyses were performed to test the robustness of the findings. Compared with aspirin alone, clopidogrel-aspirin resulted in a lifetime gain of 0.037 QALYs at an additional cost of CNY 1250 (US$ 192), yielding an incremental cost-effectiveness ratio of CNY 33 800 (US$ 5200) per QALY gained. Probabilistic sensitivity analysis showed that clopidogrel-aspirin therapy was more cost-effective in 95.7% of the simulations at a willingness-to-pay threshold recommended by the World Health Organization of CNY 105 000 (US$ 16 200) per QALY.
  
  
  CONCLUSIONS
  Early 90-day clopidogrel-aspirin regimen for acute TIA or minor stroke is highly cost-effective in China. Although clopidogrel is generic, Plavix is brand in China. If Plavix were generic, treatment with clopidogrel-aspirin would have been cost saving.
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Anxin
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Gaifen
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Xia
authors.initials: X
authors.lastname: Meng
authors.affiliation: China National Health Development Research Center, Beijing, China (K.Z.).
authors.forename: Kun
authors.initials: K
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.affiliation: Departments of Neurology and Epidemiology, University of California, San Francisco, CA (C.J.).
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002681:China; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000188:drug therapy* / Q000191:economics; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: clopidogrel; cost‐effectiveness; quality‐adjusted life‐year; stroke