title: Clopidogrel versus aspirin in patients with recent ischemic stroke and established peripheral artery disease: an economic evaluation in a Chinese setting.
abstract: OBJECTIVE
  Clopidogrel or aspirin are indicated for patients with recent ischemic stroke (IS) or established peripheral artery disease (PAD). We compared the cost effectiveness of clopidogrel with that of aspirin in Chinese patients with recent IS or established PAD.
  
  
  METHODS
  A discrete-event simulation was developed to evaluate the economic implications of secondary prevention with clopidogrel versus aspirin. All available evidence was derived from clinical studies. Costs from a Chinese healthcare perspective in 2013 US dollars and quality-adjusted life-years (QALYs) were projected over patients' lifetimes. Uncertainties were addressed using sensitivity analyses.
  
  
  RESULTS
  Compared with aspirin, clopidogrel yielded a marginally increased life expectancy by 0.46 and 0.21 QALYs at an incremental cost-effectiveness ratio of $US5246 and $US9890 per QALY in patients with recent IS and established PAD, respectively. One-way sensitivity analyses showed that the evaluation of patients with PAD and recent IS was robust except for the parameter of patient age. Given a willingness-to-pay of $US19,877 per QALY gained, clopidogrel had a probability of 90 and 68% of being cost effective in the recent IS or established PAD subgroups compared with aspirin, respectively.
  
  
  CONCLUSIONS
  The analysis suggests that clopidogrel for secondary prevention is cost effective for patients with either PAD or recent IS in a Chinese setting in comparison with aspirin.
authors.affiliation: Department of Pharmacy, Yuxi People's Hospital, affiliated with the Kunming Medical College, Yuxi, China, at1029@163.com.
authors.forename: Te
authors.initials: T
authors.lastname: Li
authors.forename: Maobai
authors.initials: M
authors.lastname: Liu
authors.forename: He
authors.initials: H
authors.lastname: Ben
authors.forename: Zhenxing
authors.initials: Z
authors.lastname: Xu
authors.forename: Han
authors.initials: H
authors.lastname: Zhong
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin