Oster G, Huse D M, Lacey M J, Epstein A M
Policy Analysis Inc., Brookline, MA 02146.
Stroke. 1994 Jun;25(6):1149-56. doi: 10.1161/01.str.25.6.1149.
Ticlopidine, an antiplatelet agent, when compared with aspirin has been found to reduce the risk of stroke in high-risk patients, ie, those with recent transient ischemic attack, reversible ischemic neurological deficit, amaurosis fugax, or minor stroke. Its cost-effectiveness in such use, however, is unknown.
We developed a model of primary stroke prevention in which a hypothetical cohort of 100 high-risk men and women 65 years of age was assumed to receive either ticlopidine (500 mg daily) or aspirin (1300 mg daily). Using published data, we estimated lifetime incidence of stroke, life expectancy (unadjusted and adjusted for changes in quality of life), and lifetime medical care costs associated with each therapy.
Patients who receive ticlopidine would experience two fewer initial strokes per hundred than those treated with aspirin. Life expectancy would be extended by approximately one-half month, and lifetime medical care costs (discounted at 5%) would increase by about $2300. The cost-effectiveness of ticlopidine, compared with aspirin, is estimated to range from $31,200 to $55,500 per quality-adjusted life-year gained as the utility of life after nonfatal stroke is assumed to vary from 0.75 to 0.95.
Ticlopidine therapy to prevent stroke in high-risk patients is cost-effective by current standards of medical practice.
噻氯匹定是一种抗血小板药物，与阿司匹林相比，已发现它可降低高危患者（即近期有短暂性脑缺血发作、可逆性缺血性神经功能缺损、一过性黑矇或轻度卒中的患者）的卒中风险。然而，其在这种用途中的成本效益尚不清楚。
我们建立了一个原发性卒中预防模型，假设一个由100名65岁高危男性和女性组成的假想队列接受噻氯匹定（每日500毫克）或阿司匹林（每日1300毫克）治疗。利用已发表的数据，我们估计了每种治疗方法的终生卒中发病率、预期寿命（未调整以及根据生活质量变化进行调整）以及终生医疗费用。
接受噻氯匹定治疗的患者每百人初始卒中发作次数比接受阿司匹林治疗的患者少两次。预期寿命将延长约半个月，终生医疗费用（按5%贴现）将增加约2300美元。由于假定非致命性卒中后生活效用在0.75至0.95之间变化，与阿司匹林相比，噻氯匹定的成本效益估计为每获得一个质量调整生命年31200美元至55500美元。
按照当前的医学实践标准，噻氯匹定治疗高危患者预防卒中具有成本效益。
