A cost-utility analysis of clopidogrel in patients with ST elevation acute coronary syndromes in the UK.
OBJECTIVE
To assess the long-term cost effectiveness of treatment for 1 month, and for 1 year with clopidogrel in addition to standard therapy (including aspirin) compared with standard therapy alone, in patients diagnosed with ST elevation acute myocardial infarction (STEMI) in the UK.


METHODS
Cost utility analysis using a cohort Markov model, incorporating clinical data from two pivotal clinical trials (the COMMIT/CCS-2 and CLARITY-TIMI 28 trials) and data from UK and non-UK observational studies.


METHODS
Health economic evaluation carried out from the perspective of the UK NHS.


METHODS
A representative cohort of 1000 UK patients aged 60 years, diagnosed with STEMI.


METHODS
75 mg/day clopidogrel, with and without a 300 mg loading dose, in addition to standard therapy (including aspirin, 75-325 mg/day) for 1 month, and for 1 year, followed by standard therapy alone for their remaining lifetime, or standard therapy alone (including aspirin, 75-325 mg/day) for their remaining lifetime.


METHODS
Incremental cost per quality-adjusted life-year (QALY) gained (ICER).


RESULTS
For the 1-month treatment option both the COMMIT/CCS-2 and CLARITY-TIMI 28 trials have ICERs below 2500 pounds. For the 1-year treatment option both trials have ICERs below 4000 pounds. Extensive univariate and probabilistic sensitivity analyses showed these results to be robust.


CONCLUSIONS
In combination with previous economic analyses of clopidogrel in NSTEMI patients, this paper demonstrates that clopidogrel appears to offer a cost-effective treatment option for all ACS patients.
Karnon
Jonathan
J
School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia. jonathan.karnon@adelaide.edu.au
Holmes
Mike W
MW
Williams
Robert
R
Bakhai
Ameet
A
Brennan
Alan
A
D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005500:Follow-Up Studies; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin