Cost Effectiveness Analysis of Cilostazol Treatment in Patients with Aneu - rysmal Subarachnoid Hemorrhage

Abstract

Objective— Cilostazol, a selective phosphodiesterase type III inhibitor, has been shown to prevent cerebral ischemia
related to cerebral vasospasm and rates of death or disability in patients with aneurysmal subarachnoid hemorrhage.
In this study, the authors’ goal was to compare the cost-effectiveness of cilostazol treatment (over no treatment) in
aneurysmal subarachnoid hemorrhage patients with secured ruptured intracranial aneurysm.
Methods— Clinical data and quality of life values were obtained from the previous randomized clinical trials. Cost
estimates were derived from the Nationwide Inpatient Data, data from long-term care in stroke patients, and relevant
literature. Incremental cost-effectiveness ratios were estimated during a 1-year period. Parametric bootstrapping was
used to determine the uncertainty of the estimates.
Results— The overall quality-adjusted life years for patients with aneurysmal subarachnoid hemorrhage treated
with cilostazol was 0.723 (95th percentile range 0.6723–0.7652) and for those not treated with cilostazol was 0.635
(95th percentile 0.5859–0.6762). The cost per quality-adjusted life years for 100 patients with aneurysmal subarach
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noid hemorrhage treated with cilostazol was $109,140.3 (95th percentile range $103,149.8-$117,403.3) and for those
not treated with cilostazol was $132,235.6 (95th percentile range $124,139.6–$143,272.2). The mean estimate incre
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mental cost-effectiveness ratios for cilostazol treatment versus no treatment was $-58,802.06 per quality-adjusted life
years gained (95% confidence interval $-58,812.17 to $-58,791.95).
Conclusions— We found that cilostazol treatment was highly cost-effective in reducing death or disability in pa
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tients with aneurysmal subarachnoid hemorrhage. A large clinical trial is warranted to evaluate the therapeutic value
of cilostazol in patients with aneurysmal subarachnoid hemorrhage.