Long-term cost-effectiveness of clopidogrel given for up to one year in patients with acute coronary syndromes without ST-segment elevation.
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.
Weintraub
William S
WS
Emory University, Atlanta, Georgia, USA. wweintr@emory.edu
Mahoney
Elizabeth M
EM
Lamy
Andre
A
Culler
Steven
S
Yuan
Yong
Y
Caro
Jaime
J
Gabriel
Sylvie
S
Yusuf
Salim
S
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
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine