Cost-effectiveness of clopidogrel in acute coronary syndromes in Canada: a long-term analysis based on the CURE trial.
BACKGROUND
Cardiovascular diseases account for nearly 20% of all hospitalizations in Canada and consume 12% of the total cost of all illnesses. With increasing trends of cardiovascular disease and increasing costs of care, development of cost-effective strategies is vital. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial demonstrated the effectiveness of clopidogrel plus acetylsalicylic acid (ASA) compared with ASA alone in reducing cardiovascular events in patients with acute coronary syndromes and, in addition, patients undergoing percutaneous coronary intervention in the Percutaneous Coronary Intervention in CURE (PCI-CURE) trial.


OBJECTIVE
To assess the cost-effectiveness of clopidogrel in the Canadian health care system.


METHODS
Estimates of hospitalization costs were based on the 2003 cost schedules released by the Health Funding and Costing Branch of the Alberta Health and Wellness, as well as on the Case Mix Group classification system. Life expectancy beyond the trial was estimated from the Saskatchewan Health Database. Cost-effectiveness was expressed as the incremental cost-effectiveness ratio, and bootstrap methods were used to estimate the joint distribution of costs and effectiveness.


RESULTS
Clopidogrel was shown to be cost-effective, with incremental cost-effectiveness ratios less than $10,000 per event prevented and less than $4,000 per life-year gained. The probability of clopidogrel resulting in cost per life-year gained of less than $20,000 was 0.975 for CURE patients and 0.904 for PCI-CURE patients.


CONCLUSIONS
The economic analysis demonstrated that clopidogrel combination therapy is not only cost-effective as antiplatelet therapy compared with ASA alone, but it is also cost-effective compared with other commonly used and openly reimbursed cardiovascular therapies in the Canadian health care system.
Kolm
Paul
P
Christiana Care Health System, Newark, Delaware, USA. pkolm@christiancare.org
Yuan
Yong
Y
Veledar
Emir
E
Mehta
Shamir R
SR
O'Brien
Judith A
JA
Weintraub
William S
WS
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy* / Q000191:economics; D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D002170:Canada; D000077144:Clopidogrel; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin