title: Long-term cost-effectiveness of early and sustained clopidogrel therapy for up to 1 year in patients undergoing percutaneous coronary intervention after presenting with acute coronary syndromes without ST-segment elevation.
abstract: BACKGROUND
  The superiority of clopidogrel and aspirin versus aspirin alone for up to 1 year in patients who undergo percutaneous coronary intervention (PCI) after presenting with acute coronary syndromes without ST-segment elevation was demonstrated in the PCI-CURE study. We evaluated the long-term cost-effectiveness of clopidogrel use for up to 1 year using patient-level outcomes and resource use from PCI-CURE, and estimates of life expectancy gains based on external sources.
  
  
  METHODS
  PCI-CURE involved 2658 patients who underwent PCI between 1998 and 2000 after being randomized in the CURE trial to clopidogrel (n = 1313) or placebo (n = 1345). Roughly two thirds (clopidogrel n = 821, placebo n = 909) underwent PCI during the initial hospitalization (early PCI). Costs were applied to hospitalizations according to diagnosis-related group. Clopidogrel was assigned the average wholesale price of 3.22 dollars per day. Life expectancy gains resulting from the prevention of major clinical events were estimated using external sources.
  
  
  RESULTS
  Average total costs were higher with clopidogrel (difference [based on costing method] 253 dollars-423 dollars). For patients who underwent PCI during the initial hospitalization, the difference ranged from 155 dollars lower to 90 dollars higher with clopidogrel. The estimated life expectancy gain with clopidogrel was 0.0885 years, whereas it was 0.0962 years for the early PCI subgroup. Incremental cost per year of life gained with clopidogrel ranges from 2856 dollars to 4775 dollars overall and from dominant (life expectancy benefit with cost savings) to 935 dollars for the early PCI subgroup.
  
  
  CONCLUSIONS
  Clopidogrel given for up to 1 year in patients undergoing PCI after presentation with acute coronary syndromes is a highly cost-effective treatment strategy.
authors.affiliation: New England Research Institutes, Watertown, MA 02472, USA. emahoney@neri.org
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Mahoney
authors.forename: Shamir
authors.initials: S
authors.lastname: Mehta
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.forename: Joseph
authors.initials: J
authors.lastname: Jackson
authors.forename: Roland
authors.initials: R
authors.lastname: Chen
authors.forename: Sylvie
authors.initials: S
authors.lastname: Gabriel
authors.forename: Andre
authors.initials: A
authors.lastname: Lamy
authors.forename: Steven
authors.initials: S
authors.lastname: Culler
authors.forename: Jaime
authors.initials: J
authors.lastname: Caro
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013577:Syndrome; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine