Cost-effectiveness of clopidogrel treatment in percutaneous coronary intervention: a European model based on a meta-analysis of the PCI-CURE, CREDO and PCI-CLARITY trials.
OBJECTIVE
Our objective was to conduct a comprehensive cost-effectiveness analysis of pre-treatment and long-term treatment with clopidogrel in percutaneous coronary intervention (PCI) in three European countries based on a meta-analysis of the PCI-Clopidogrel in Unstable angina to prevent Recurrent Events (CURE), Clopidogrel for the Reduction of Events During Observation (CREDO) and PCI-Clopidogrel as Adjunctive Therapy (CLARITY) trials. This analysis adds to existing knowledge by providing further data on the cost-effectiveness of clopidogrel in PCI across a wide spectrum of patients.


METHODS
A combined decision tree and Markov model was created. The relative risks of myocardial infarction, cardiovascular death and of major bleedings with clopidogrel were based on a fixed-effects meta-analysis. The risk of ischaemic events in untreated patients and long-term survival were taken from the Swedish hospital and death registers. A societal perspective was used in Sweden and a payer perspective in Germany and France. Costs are stated in euro2006 and effectiveness measured in quality-adjusted life-years (QALYs).


RESULTS
The pooled effects of clopidogrel on the combined endpoint showed a relative risk of 0.711 (p=0.003) at 30 days and 0.745 (p=0.002) at end of follow-up (up to 1 year). Pre-treatment with clopidogrel compared with aspirin alone is a dominant strategy. Long-term treatment with clopidogrel compared with 1-month treatment leads to approximately 0.09 QALYs at an incremental cost of euro393 in Sweden, euro709 in Germany and euro494 in France. The corresponding incremental cost-effectiveness ratios range from euro4225/QALY to euro7871/QALY.


CONCLUSIONS
The results of this modelling analysis suggest that pre-treatment and long-term treatment in PCI with clopidogrel for up to 1 year are cost-effective in a range of patient groups and settings given commonly accepted thresholds.
i3 Innovus, Stockholm, Sweden. jenny.berg@i3innovus.com
Jenny
J
Berg
Dogan
D
Fidan
Peter
P
Lindgren
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D005060:Europe; D006801:Humans; D008390:Markov Chains; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D015233:Models, Statistical; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000191:economics*; D012306:Risk; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine