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Economic effects of prolonged clopidogrel therapy after percutaneous coronary intervention
Patricia A Cowper1, Krishna Udayakumar, Michael H Sketch
1Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. cowpe001@mc.duke.edu
Insights
Extending clopidogrel therapy to one year after percutaneous coronary intervention (PCI) is cost-effective. This prolonged treatment reduces myocardial infarction (MI) risk, offering economic benefits, especially for high-risk patients.
Area of Science:
- Cardiology
- Health Economics
- Clinical Pharmacy
Background:
- Clinical trials indicate that extending clopidogrel therapy post-PCI reduces cardiac events.
- However, the prolonged use of clopidogrel incurs significant costs and elevates bleeding risks.
Purpose of the Study:
- To evaluate the incremental cost-effectiveness of extending clopidogrel therapy from one month to one year after percutaneous coronary intervention (PCI).
- To assess the economic viability of prolonged clopidogrel use in a diverse patient population.
Main Methods:
- Decision analysis model comparing one-month versus one-year clopidogrel therapy post-PCI.
- Utilized event rates from 3,976 PCI patients (1999-2001) and CREDO trial data for treatment effects.
- Incorporated published data for unit costs and the impact of myocardial infarction (MI) on life expectancy.
Main Results:
- Extending clopidogrel therapy to one year post-PCI incurred an additional cost of $879 per patient.
- This strategy reduced the risk of MI by 2.6%.
- The cost per year of life saved was calculated at $15,696, assuming MI reduces life expectancy by two years.
Conclusions:
- Prolonging clopidogrel therapy for one year after PCI presents an economically attractive strategy.
- The cost-effectiveness is particularly pronounced in high-risk patient populations.
Objectives:
This study examined the incremental cost-effectiveness of extending clopidogrel therapy from one month to one year after percutaneous coronary intervention (PCI) in an unselected, heterogeneous patient population.
Background:
Clinical trials suggest that prolonging clopidogrel therapy for up to one year after PCI reduces downstream cardiac events. However, clopidogrel therapy is costly and may increase bleeding risk.
Methods:
Using decision analysis, we compared the outcomes and cost of prolonging clopidogrel treatment from one month to one year after PCI with the alternative strategy of discontinuing therapy one month after the procedure. Event rates were based on 3,976 PCI patients who were treated between January 1999 and December 2001 at the Duke Medical Center and received no more than one month of clopidogrel after the procedure. Baseline characteristics and event rates were obtained from Duke clinical information systems. The effect of prolonged clopidogrel therapy on event rates was based on the Clopidogrel for the Reduction of Events During Observation (CREDO) trial per-protocol data. Unit costs and the effect of myocardial infarction (MI) on life expectancy were based on published sources.
Results:
Extending clopidogrel therapy from one month to one year after PCI cost USD 879 per patient and reduced the risk of MI by 2.6%. Assuming MI decreases life expectancy by two years, prolonged therapy would cost USD 15,696 per year of life saved. Economic attractiveness of therapy varied with baseline risk, the effect of prolonged therapy on MI risk, and the price of clopidogrel.
Conclusions:
Prolonging clopidogrel therapy for one year after PCI is economically attractive, particularly in high-risk patients.
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