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Long-term cost-effectiveness of clopidogrel given for up to one year in patients with acute coronary syndromes
William S Weintraub1, Elizabeth M Mahoney, Andre Lamy
1Emory University, Atlanta, Georgia, USA. wweintr@emory.edu
Insights
Clopidogrel is effective and cost-effective for preventing events in acute coronary syndrome (ACS) patients. This platelet inhibition therapy, used for up to one year, offers significant long-term benefits.
Area of Science:
- Cardiovascular Medicine
- Pharmacoeconomics
- Clinical Trials
Background:
- The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial demonstrated clopidogrel's efficacy for up to one year post-acute coronary syndrome (ACS).
- Patients received clopidogrel plus aspirin versus placebo plus aspirin, with treatment duration averaging nine months.
Purpose of the Study:
- To evaluate the long-term cost-effectiveness of clopidogrel therapy.
- To assess clopidogrel's value in patients experiencing non-ST-segment elevation acute coronary syndrome (ACS).
Main Methods:
- Utilized patient-level clinical outcomes and resource use data from the CURE trial.
- Incorporated external data to estimate life expectancy gains from preventing death, stroke, and myocardial infarction.
Main Results:
- Excluding drug costs, hospitalizations were $325 less in the clopidogrel arm.
- Including clopidogrel costs, total costs were $442 higher, with an incremental cost-effectiveness ratio (ICER) of approximately $6,300-$6,500 per life-year gained.
- The majority of ICER estimates were below $50,000 per life-year gained.
Conclusions:
- Clopidogrel therapy following an acute coronary syndrome (ACS) is effective in preventing major adverse cardiovascular events.
- The long-term use of clopidogrel for up to one year post-ACS is a cost-effective treatment strategy.
Objectives:
We sought to evaluate the long-term cost-effectiveness of clopidogrel for up to one year after an acute coronary syndrome (ACS) without ST-segment elevation.
Background:
The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, a randomized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000. Patients were given clopidogrel (300-mg load followed by 75 mg/day) versus placebo, both in addition to aspirin, for a mean of nine months.
Methods:
We used patient-level clinical outcomes and resource use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death, stroke, and myocardial infarction on the basis of data from external sources.
Results:
Excluding clopidogrel costs, average costs of hospitalizations alone were 325 dollars less for the clopidogrel arm (95% confidence interval -722 dollars to 45 dollars) using diagnosis-related group-based Medicare reimbursement rates. When including clopidogrel costs (766 dollars greater for the clopidogrel arm), average total costs were 442 dollars higher for the clopidogrel arm (95% confidence interval 62 dollars to 820 dollars). The incremental cost-effectiveness ratio (ICER) on the basis of the Framingham Heart Study was 6,318 dollars per life-year gained (LYG) with clopidogrel, with 94% of bootstrap-derived ICER estimates <50,000 dollars/LYG; based on Saskatchewan, the ICER was 6,475 dollars/LYG with 98% of estimates <50,000 dollars.
Conclusions:
Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective.
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