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I congratulate Dr Sarasin and his colleagues for their detailed cost-effectiveness analysis of antiplatelet therapy in cerebrovascular disease.¹ They conclude that the combination of aspirin and dipyridamole is "more effective and less costly than aspirin alone." However, this conclusion hinges on 2 key assumptions that are flawed, particularly for medical care in the United States.

The authors estimated the daily costs for aspirin, clopidogrel, and the aspirin/dipyridamole combination at $0.02, $2.40, and $0.60, respectively. In the sensitivity analysis, the highest daily cost considered for aspirin/dipyridamole was $1.20. While this cost may be appropriate for the aspirin/dipyridamole combination available in Europe, it is a significant underestimate for the United States. In the United States, based on a 30-day pricing period, the average wholesale price for aspirin/dipyridamole is $2.95 per day, only slightly lower than that of clopidogrel ($3.21 per day) (oral communication with Boehringer Ingleheim Pharmaceuticals, Inc, Ridgefield, Conn, and Bristol-Myers . . . [Full Text of this Article]

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