title: Long-term cost-effectiveness of clopidogrel given for up to one year in patients with acute coronary syndromes without ST-segment elevation.
abstract: OBJECTIVE
  We sought to evaluate the long-term cost-effectiveness of clopidogrel for up to one year after an acute coronary syndrome (ACS) without ST-segment elevation.
  
  
  BACKGROUND
  The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, a randomized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000. Patients were given clopidogrel (300-mg load followed by 75 mg/day) versus placebo, both in addition to aspirin, for a mean of nine months.
  
  
  METHODS
  We used patient-level clinical outcomes and resource use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death, stroke, and myocardial infarction on the basis of data from external sources.
  
  
  RESULTS
  Excluding clopidogrel costs, average costs of hospitalizations alone were 325 dollars less for the clopidogrel arm (95% confidence interval -722 dollars to 45 dollars) using diagnosis-related group-based Medicare reimbursement rates. When including clopidogrel costs (766 dollars greater for the clopidogrel arm), average total costs were 442 dollars higher for the clopidogrel arm (95% confidence interval 62 dollars to 820 dollars). The incremental cost-effectiveness ratio (ICER) on the basis of the Framingham Heart Study was 6,318 dollars per life-year gained (LYG) with clopidogrel, with 94% of bootstrap-derived ICER estimates <50,000 dollars/LYG; based on Saskatchewan, the ICER was 6,475 dollars/LYG with 98% of estimates <50,000 dollars.
  
  
  CONCLUSIONS
  Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective.
authors.affiliation: Emory University, Atlanta, Georgia, USA. wweintr@emory.edu
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Mahoney
authors.forename: Andre
authors.initials: A
authors.lastname: Lamy
authors.forename: Steven
authors.initials: S
authors.lastname: Culler
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.forename: Jaime
authors.initials: J
authors.lastname: Caro
authors.forename: Sylvie
authors.initials: S
authors.lastname: Gabriel
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000208:Acute Disease; D000368:Aged; D000077144:Clopidogrel; D003327:Coronary Disease / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008017:Life Expectancy; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013577:Syndrome; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use*; D013995:Time; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine