The value of clopidogrel in addition to standard therapy in reducing atherothrombotic events

The recent multinational, randomised, prospective studies Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE), Percutaneous Coronary Intervention substudy of CURE (PCI-CURE) and Clopidogrel for the Reduction of Events During Observation (CREDO) have demonstrated the clinical efficacy and safety of clopidogrel for the treatment of patients with non-ST-segment elevation acute coronary syndromes (ACS), including those undergoing percutaneous coronary intervention. In these settings, clopidogrel significantly reduces the risk of atherothrombotic events, with relative risk reductions of 20-30% (absolute risk reduction 1.9-3.0%). Health economic evaluations based on data from these studies conducted in Europe and the United States have clearly demonstrated the cost-effectiveness of clopidogrel in combination with aspirin compared with aspirin alone for the management of ACS. Within-trial evaluations based on CURE and PCI-CURE data showed that treatment with clopidogrel on top of standard therapy reduced the cost of initial hospitalisation as well as the total cost associated with hospitalisations. Long-term economic analyses based on the CURE study demonstrate that clopidogrel is cost saving in the Netherlands and that the cost per life-year gained (LYG) in other European countries is between Euros 549 and Euros 5048. In the United States, the cost per LYG for clopidogrel has been assessed at US dollars 6173 on the basis of CURE, US dollars 5910 for PCI-CURE and US dollars 3685 for CREDO, all of which are considerably lower than that associated with common cardiovascular benchmarks. The results are robust and consistent across different countries using varying costing strategies and estimates of survival. In conclusion, these data demonstrate that clopidogrel in combination with aspirin for the management of ACS is both clinically effective and cost-effective in this setting.