title: The cost of clopidogrel use in atrial fibrillation in the ACTIVE-A trial.
abstract: BACKGROUND
  The Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events-Aspirin (ACTIVE-A) demonstrated that in patients with atrial fibrillation unsuitable for vitamin K antagonist (VKA) therapy, a combination of clopidogrel and aspirin reduced stroke risk by 28% but increased major hemorrhage risk by 57%. This analysis examined cost implications of adding clopidogrel to aspirin (C+A) for ACTIVE-A patients.
  
  
  METHODS
  Health care use was extracted for each patient. We considered only direct costs and included only hospitalization events. We used Canadian unit costs for the health care resources consumed and Canadian list price of brand clopidogrel. Costs, in 2008 Canadian dollars, were discounted at 3% per year.
  
  
  RESULTS
  C+A reduced costs of health care use components except for the study medication. Stroke prevention resulted in important cost savings that offset the cost of clopidogrel. Total costs per patient for C+A were $14,132 (95% confidence interval [CI], $13,445-$14,842), compared with $13,756 (95% CI, $13,032-$14,544) for aspirin alone, resulting in incremental cost of $376 (95% CI, -$645 to $1397) for C+A, confirmed through bootstrap simulation. Estimates were sensitive to the price of clopidogrel, varying from cost savings to a significant increase.
  
  
  CONCLUSIONS
  C+A in patients unsuitable for VKA therapy is cost neutral (following our predefined conditions) as cost of clopidogrel is offset by prevention of costly strokes. These findings support the use of C+A in ACTIVE-A patients for whom VKA therapy is unsuitable.
authors: CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada. lamya@mcmaster.ca
authors: Andre
authors: A
authors: Lamy
authors: Wesley
authors: W
authors: Tong
authors: Peggy
authors: P
authors: Gao
authors: Susan
authors: S
authors: Chrolavicius
authors: Amiram
authors: A
authors: Gafni
authors: Salim
authors: S
authors: Yusuf
authors: Stuart J
authors: SJ
authors: Connolly
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics; D002170:Canada; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine