{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:20:06Z","timestamp":1780582806943,"version":"3.54.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,6,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The objective of the study was to assess the cost\u2010effectiveness of cilostazol (a selective phosphodiesterase 3 inhibitor) added to aspirin or clopidogrel for secondary stroke prevention in patients with noncardioembolic stroke.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">A Markov model decision tree was used to examine lifetime costs and quality\u2010adjusted life years (QALYs) of patients with noncardioembolic stroke treated with either aspirin or clopidogrel or with additional cilostazol 100\u00a0mg twice daily. Cohorts were followed until all patients died from competing risks or ischemic or hemorrhagic stroke. Probabilistic sensitivity analysis using Monte Carlo simulation was used to model 10\u00a0000 cohorts of 10\u00a0000 patients. The addition of cilostazol to aspirin or clopidogrel is strongly cost saving. In all 10\u00a0000 simulations, the cilostazol strategy resulted in lower health care costs compared with aspirin or clopidogrel alone (mean $13\u00a0488 cost savings per patient; SD, $8087) and resulted in higher QALYs (mean, 0.585 more QALYs per patient lifetime; SD, 0.290). This result remained robust across a variety of sensitivity analyses, varying cost inputs, and treatment effects. At a willingness\u2010to\u2010pay threshold of $50\u00a0000\/QALY, average net monetary benefit from the addition of cilostazol was $42\u00a0743 per patient over their lifetime.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Based on the best available data, the addition of cilostazol to aspirin or clopidogrel for secondary prevention following noncardioembolic stroke results in significantly reduced health care costs and a gain in lifetime QALYs.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.024992","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T10:39:43Z","timestamp":1654252783000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Cost\u2010Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3064-0864","authenticated-orcid":false,"given":"Lily W.","family":"Zhou","sequence":"first","affiliation":[{"name":"Stanford Stroke Center Stanford University Palo Alto CA"},{"name":"Division of Neurology and Vancouver Stroke Program University of British Columbia Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lironn","family":"Kraler","sequence":"additional","affiliation":[{"name":"Stanford Stroke Center Stanford University Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"de Havenon","sequence":"additional","affiliation":[{"name":"Department of Neurology Yale University New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3545-6927","authenticated-orcid":false,"given":"Maarten G.","family":"Lansberg","sequence":"additional","affiliation":[{"name":"Stanford Stroke Center Stanford University Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000375"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.035002"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.029454"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005344-200210000-00011"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1159\/000138400"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2006.01.022"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.70.453"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(19)30148-6"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104450"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.027465"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)09457-3"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30392-0"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987316683780"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2331030863"},{"key":"e_1_3_1_16_2","unstructured":"Enterprise web application support . 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