The cost-effectiveness of dual oral antiplatelet therapy following percutaneous coronary intervention: a Swedish analysis of the CREDO trial.
The CREDO trial demonstrated the clinical efficacy of 12-month antiplatelet therapy with clopidogrel compared to standard 28-day treatment with a 27% relative reduction in the combined risk of death, myocardial infarction, or stroke in patients undergoing percutaneous coronary intervention (PCI) and being treated with aspirin. This study evaluated the long-term cost-effectiveness of 12-month vs. 28-day therapy with clopidogrel in Sweden. A Markov model was developed which assumed a hypothetical cohort of patients in a post-PCI state to have certain risks of suffering one of the endpoints of the CREDO trial: stroke, myocardial infarction, or death. The model predicted a mean survival of 12.098 years in the 12-month arm vs. 12.026 in the 28-day arm, an incremental gain of 0.072 life-years. The gain in survival came at a predicted incremental cost of Euro 217, resulting in an incremental cost-effectiveness ratio of Euro 3,022. Thus the predicted cost-effectiveness ratio of long-term treatment with clopidogrel in patients undergoing PCI is well below the threshold values currently considered cost-effective.
Ringborg
Anna
A
Stockholm Health Economics, Stockholm, Sweden. anna.r@healtheconomics.se
Lindgren
Peter
P
Jönsson
Bengt
B
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000191:economics*; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D013548:Sweden / Q000453:epidemiology; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin