Clopidogrel versus aspirin in patients with atherothrombosis: CAPRIE-based calculation of cost-effectiveness for Germany.
OBJECTIVE
To model the 2-year cost-effectiveness of secondary prevention with clopidogrel versus aspirin (acetylsalicylic acid) (ASS) in German patients with myocardial infarction (MI), ischaemic stroke (IS) or diagnosed with peripheral arterial disease (PAD), based on CAPRIE trial data and from the perspective of German third party payers (TPP).


METHODS
An existing Markov model was adapted to Germany by using German cost data. The model was extended by using different datasets for cardiovascular event survival times (Framingham vs. Saskatchewan health databases) and in two separate scenarios.


RESULTS
The treatment with clopidogrel leads to a reduction of 13.19 vascular events per 1000 patients, of which 2.21 are vascular deaths. The overall incremental costs for the 2-year management of atherothrombotic patients with clopidogrel instead of ASS are calculated to be about euro1 241 440 per 1000 patients. The number of life-years saved (LYS) has been calculated as the difference in the number of life-years lost due to vascular death or events with ASS versus clopidogrel: it is 86.35 LYS when analysis is based on Framingham data and 66.07 LYS with Saskatchewan-based survival data. The incremental costs per LYS are euro14 380 and euro18 790, respectively. Cost-effectiveness is sensitive to changes in survival data, discounting and daily costs of clopidogrel, but stable against substantial (+/- 25%) changes in all other cost data.


CONCLUSIONS
The findings for Germany are in line with published results for Belgium (euro13 390 per LYS) and also with results for Italy (euro17 500 per LYS), both based on Saskatchewan data, and with a French analysis based on Framingham data (euro15 907 per LYS). Even if no officially accepted cost-effectiveness threshold exists for Germany at present, incremental cost-effectiveness results of less than euro20 000 per LYS for the treatment with clopidogrel can be assumed to be acceptable for German third party payers.
University Hospital Munich, Department of Hemostaseology and Transfusion Medicine, Economic Working Group, Ziemssenstrasse 1, D-80336 Munich, Germany. Karin.Berger@med.uni-muenchen.de
K
K
Berger
F
F
Hessel
J
J
Kreuzer
A
A
Smala
H C
HC
Diener
D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000191:economics* / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D000077144:Clopidogrel; D015331:Cohort Studies; D003328:Coronary Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D005858:Germany; D006801:Humans; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D016019:Survival Analysis; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin