[Cost-effectiveness of clopidogrel vs. aspirin treatment in high-risk acute coronary syndrome patients in Denmark].
BACKGROUND
The aim of this study was to estimate the cost-effectiveness of clopidogrel versus aspirin (ASA) in Denmark in the secondary prevention of cardiovascular events in three high-risk CAPRIE populations: (1) patients with a history of coronary artery bypass grafting, (2) patients with a history of ischemic events and (3) patients with multiple vascular territory involvement. Additionally, the cost-effectiveness of clopidogrel versus no treatment in ASA-intolerant patients was estimated.


METHODS
Clinical, epidemiological and cost data (Danish estimates) were combined in a Markov model. Estimates of transition probabilities were derived from post hoc analyses of the CAPRIE database.


RESULTS
Cost-effectiveness (CE) ratios ranged from 25,445 Danish kroner per LYG (life year gained) in patients with a history of CABG to 55,503 Danish kroner per LYG in patients with multiple vascular territory involvement. The estimated cost-effectiveness ratio of clopidogrel in ASA-intolerant patients was significantly lower (3,093 Danish kroner per LYG). Sensitivity analyses showed that the order of magnitude of these CE ratios is unaffected by changes in model assumptions.


CONCLUSIONS
In a Danish setting, clopidogrel may be considered a cost-effective treatment alternative to ASA for the secondary prevention of cardiovascular events in high-risk populations. Clopidogrel is also an effective and cost-effective treatment for ASA-intolerant patients.
Heeg
Bart
B
Torben H. Haghfelt PharMerit, Rotterdam, Holland.
van Gestel
Aukje
A
Hout
Ben van
Bv
Olsen
Jens
J
Haghfelt
Torben H
TH
D000208:Acute Disease; D000368:Aged; D001241:Aspirin / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006801:Humans; D007511:Ischemia / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D007866:Leg / Q000098:blood supply; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D013577:Syndrome; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin