Evaluating Economic Outcomes: Single-Use Aspirin vs. Aspirin-Clopidogrel in Ischemic Stroke Patients Based on Barthel Index Scores
Main Article Content
Abstract
Ischemic stroke is a catastrophic disease that causes large costs in Indonesia. The high prevalence of stroke results in increased morbidity and mortality rates, which will impact the socioeconomic status of stroke patients. Cost Effectiveness Analysis (CEA) is a method in pharmaco-economics that aims to make decisions regarding the rational choice of therapy and evaluate the economic impact on ischemic stroke patients. This study aims to determine the Incremental Cost Effectiveness Ratio (ICER) value of antiplatelet therapy in the aspirin-clopidogrel combination group and the single aspirin group in ischemic stroke patients treated at the Regional General Hospital. Dr. M. Djamil Padang. The clinical parameter observed was the Barthel Index (BI) value. This research is a descriptive study with retrospective data collection using medical record data and the Hospital Management Information System (SIMRS) at RSUD Dr. M.Djamil Padang. The cost data shows the total direct medical costs incurred in treating ischemic stroke. Based on the results obtained, the Incremental Cost Effectiveness Ratio (ICER) value is IDR (-) 401,302. 71 per 1% increase. In this study it can be concluded that the aspirin-clopidogrel combination has better cost effectiveness than aspirin alone.
Article Details

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright and grant the journal the right of first publication simultaneously under the Creative Commons Attribution License. This license allows others to share the work with proper acknowledgment of authorship and initial publication in this journal. Authors are permitted and encouraged to deposit their articles in institutional repositories, on their personal websites, or in other online repositories after the article has been published in JSFK.
References
. Luengo-Fernandez R, Gray AM, Bull L, Welch S, Cuthbertson F, Rothwell PM. Quality of life after TIA and stroke: ten-year results of the Oxford Vascular Study. Neurology. 2013;81(18):1588–95. https://doi.org/10.1212/WNL.0b013e3182a9f45f
. International Diabetes Federation. IDF Atlas [Internet]. International Diabetes Federation; 2021. 1–141 p. https://doi.org/10.1016/j.diabres.2013.10.013
. Kusuma Y, Venketasubramanian N, Kiemas LS, Misbach J. Burden of stroke in Indonesia. Int J Stroke. 2009;4(5):379–80. https://doi.org/10.1111/j.1747-4949.2009.00326.x
. National Institute of Health Research and Development. Laporan Provinsi Sumatera Barat Riskesdas 2018. Jakarta: Kemenkes RI; 2019.
. National Institute of Health Research and Development. Laporan Nasional Riskesdas 2018. Jakarta: Kemenkes RI; 2019.
. Guzik A, Bushnell C. Stroke Epidemiology and Risk Factor Management. Continuum (Minneap Minn). 2017;23(1, Cerebrovascular Disease):15–39. https://doi.org/10.1212/CON.0000000000000416
. Benesch C, Glance LG, Derdeyn CP, Fleisher LA, Holloway RG, Messé SR, et al. Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association. Circulation. 2021;143(19):e923–46. https://doi.org/10.1161/CIR.0000000000000968
. Montaño A, Hanley DF, Hemphill JC 3rd. Hemorrhagic stroke. Handb Clin Neurol. 2021;176:229–48. https://doi.org/10.1016/B978-0-444-64034-5.00019-5
. Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Patel T, Ho CH, et al. Medication self-management interventions for persons with stroke: A scoping review. PLoS One. 2023;18(5):e0285483. https://doi.org/10.1371/journal.pone.0285483
. Najmiatul FFPYOS. EE165 Cost-Effectiveness Analysis Model of Aspirin and Aspirin Combination Therapy in Acute Ischemic Stroke Patient in West Sumatera. Value Heal. 2022;25(7). https://doi.org/https://doi.org/10.1016/j.jval.2022.04.414
. Mauskopf JA, Boye KS, Schmitt C, McCollam P, Birt J, Juniper MD, et al. Adherence to guidelines for sensitivity analysis: cost-effectiveness analyses of dual oral antiplatelet therapy. J Med Econ. 2009;12(2):141–53. https://doi.org/10.3111/13696990903123813
. Zhou LW, Kraler L, de Havenon A, Lansberg MG. Cost-Effectiveness of Cilostazol Added to Aspirin or Clopidogrel for Secondary Prevention After Noncardioembolic Stroke. J Am Heart Assoc. 2022;11(11):e024992. https://doi.org/10.1161/JAHA.121.024992
. Oza R, Rundell K, Garcellano M. Recurrent Ischemic Stroke: Strategies for Prevention. Am Fam Physician. 2017;96(7):436–40.
. Cannon CP. Cost-effectiveness of clopidogrel. Vol. 22 Suppl 4, PharmacoEconomics. New Zealand; 2004. p. 1–3. https://doi.org/10.2165/00019053-200422004-00002
. Barthels D, Das H. Current advances in ischemic stroke research and therapies. Biochim Biophys acta Mol basis Dis. 2020;1866(4):165260. https://doi.org/10.1016/j.bbadis.2018.09.012
. Choi SE, Sagris D, Hill A, Lip GYH, Abdul-Rahim AH. Atrial fibrillation and stroke. Expert Rev Cardiovasc Ther. 2023;21(1):35–56. https://doi.org/10.1080/14779072.2023.2160319
. Campbell BC V, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Prim. 2019;5(1):70. https://doi.org/10.1038/s41572-019-0118-8
. Avan A, Digaleh H, Di Napoli M, Stranges S, Behrouz R, Shojaeianbabaei G, et al. Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017. BMC Med. 2019;17(1):191. https://doi.org/10.1186/s12916-019-1397-3
. BPJS Kesehatan. Info BPJS. Implementasi prolanis di masa pandemi Covid-19. Jakarta: BPJS Kesehatan; 2020.
. Fuady A. Arsitektur Jaminan Kesehatan Indonesia. 1st ed. Jakarta: Sagung Seto; 2019. 1–300 p.
. Fuady A, Houweling TAJ, Mansyur M, Richardus JH. Catastrophic total costs in tuberculosis-affected households and their determinants since Indonesia’s implementation of universal health coverage. Infect Dis Poverty. 2018;7(1):1–14. https://doi.org/10.1186/s40249-017-0382-3
. Fitria N, Fitri Anggraini L, Oktavia Sari Y. Cost-Effectiveness Analysis of the Combination of Metformin-Insulin Glargine and Metformin-Glimepiride in Type 2 Diabetes Mellitus Patients in Rupit Hospital. Vol. 1, Journal of Health Economic and Policy Research JHEPR. Purwokerto; 2023.
. Fitria N, Idrus L, Putri AR, Sari YO. The usability testing of the integrated electronic healthcare services for diabetes mellitus patients during the pandemic in Indonesia. Digit Heal. 2023;9:20552076231173228. https://doi.org/10.1177/20552076231173227
. Fitria N, Andela M, Syaputri YZ. Analisis Efektivitas Biaya Penggunaan Metformin- Glimepirid Terhadap Penurunan Kadar Gula Darah Puasa Pada Pasien Diabetes Mellitus Tipe 2 di Rumah Sakit Universitas Andalas. 2022;202–7. https://doi.org/10.25077/jsfk.9.sup.202-207.2022
. Aghoram R, Kumar SM, Rajasulochana SR, Kar SS, Aggarwal R. Cost-Utility Analysis of Dabigatran and Warfarin for Stroke Prevention Among Patients With Nonvalvular Atrial Fibrillation in India. Value Heal Reg issues. 2022;31:119–26. https://doi.org/10.1016/j.vhri.2022.04.007
. López-López JA, Sterne JAC, Thom HHZ, Higgins JPT, Hingorani AD, Okoli GN, et al. Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis. BMJ. 2017;359:j5058. https://doi.org/10.1136/bmj.j5058
. Saito I, Kobayashi M, Matsushita Y, Mori A, Kawasugi K, Saruta T. Cost-utility analysis of antihypertensive combination therapy in Japan by a Monte Carlo simulation model. Hypertens Res. 2008;31(7):1373–83. https://doi.org/10.1291/hypres.31.1373
. Rahayu UB, Wibowo S, Setyopranoto I, Hibatullah Romli M. Effectiveness of physiotherapy interventions in brain plasticity, balance and functional ability in stroke survivors: A randomized controlled trial. NeuroRehabilitation. 2020;47(4):463–70. https://doi.org/10.3233/NRE-203210
. Yang H, Chen Y, Wang J, Wei H, Chen Y, Jin J. Activities of daily living measurement after ischemic stroke: Rasch analysis of the modified Barthel Index. Medicine (Baltimore). 2021;100(9):e24926. https://doi.org/10.1097/MD.0000000000024926
. Fitria N, van Asselt ADI, Postma MJ. Cost-effectiveness of controlling gestational diabetes mellitus: a systematic review. Eur J Heal Econ. 2019;20(3). https://doi.org/10.1007/s10198-018-1006-y
. Andy F. Discover statistics using SPSS-third edition. Vol. 82, Revista Mexicana de Biodiversidad. 2011. 179–191 p.
. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global Burden of Hypertension: Analysis of Worldwide Data. Lancet. 2005;365(9455):217–23. https://doi.org/10.1016/S0140-6736(05)70151-3
. Mulugeta SS. Geographical disparities and determinants of adherence to iron folate supplementation among pregnant women in Ethiopia: spatial and multilevel analysis of the Ethiopian Mini Demographic and Health Survey of 2019. BMJ Open. 2022;12(9):e061900. https://doi.org/10.1136/bmjopen-2022-061900
. Liu F, Tsang RC, Zhou J, Zhou M, Zha F, Long J, et al. Relationship of Barthel Index and its Short Form with the Modified Rankin Scale in acute stroke patients. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2020;29(9):105033. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105033
. Ohura T, Hase K, Nakajima Y, Nakayama T. Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients. BMC Med Res Methodol. 2017;17(1):131. https://doi.org/10.1186/s12874-017-0409-2