Cost-effectiveness of clopidogrel in myocardial infarction with ST-segment elevation: a European model based on the
Jenny Berg1, Peter Lindgren, Julie Spiesser
1European Health Economics, Stockholm, Sweden. jenny.b@healtheconomics.se
Insights
Clopidogrel treatment for ST-segment elevation myocardial infarction (STEMI) proved cost-effective across three European countries. This analysis, using data from CLARITY and COMMIT trials, showed significant life-years gained and favorable incremental cost-effectiveness ratios.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Pharmacoeconomics
Background:
- Previous health economic studies indicate clopidogrel is cost-effective for preventing ischemic events in non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina.
- This study extends the analysis to ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To assess the cost-effectiveness of clopidogrel in short- and long-term treatment of STEMI.
- Utilizing data from the CLARITY and COMMIT trials conducted in Sweden, Germany, and France.
Main Methods:
- A combined decision tree and Markov model was employed for analysis.
- Data from the CURE trial (NSTEMI) were integrated with 1-month data from CLARITY and COMMIT for a 1-year treatment model.
- The model incorporated risks of death, myocardial infarction, stroke, and long-term survival from Swedish registries, focusing on direct medical costs from a payer perspective.
Main Results:
- Clopidogrel treatment up to 1 year yielded 0.144 life-years gained (LYG) in the CLARITY cohort.
- In Sweden and France, the strategy was dominant with cost savings; in Germany, the incremental cost-effectiveness ratio (ICER) was €92/LYG.
- For the COMMIT cohort, clopidogrel treatment resulted in 0.194 LYG with ICERs ranging from €2772/LYG to €4144/LYG across the three countries.
Conclusions:
- Clopidogrel treatment for STEMI patients demonstrated cost-effectiveness in all three studied European countries.
- The predicted incremental cost-effectiveness ratios (ICERs) fell below generally accepted threshold values, supporting its use.
Background:
Several health economic studies have shown that the use of clopidogrel is cost-effective to prevent ischemic events in non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina.
Objective:
This study was designed to assess the cost-effectiveness of clopidogrel in short- and long-term treatment of ST-segment elevation myocardial infarction (STEMI) with the use of data from 2 trials in Sweden, Germany, and France: CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) and COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial).
Methods:
A combined decision tree and Markov model was constructed. Because existing evidence indicates similar long-term outcomes after STEMI and NSTEMI, data from the long-term NSTEMI CURE trial (Clopidogrel in Unstable Angina to Prevent Recurrent Events) were combined with 1-month data from CLARITY and COMMIT to model the effect of treatment up to 1 year. The risks of death, myocardial infarction, and stroke in an untreated population and long-term survival after all events were derived from the Swedish Hospital Discharge and Cause of Death register. The model was run separately for the 2 STEMI trials. A payer perspective was chosen for the comparative analysis, focusing on direct medical costs. Costs were derived from published sources and were converted to 2005 euros. Effectiveness was measured as the number of life-years gained (LYG) from clopidogrel treatment.
Results:
In a patient cohort with the same characteristics and event rates as in the CLARITY population, treatment with clopidogrel for up to 1 year resulted in 0.144 LYG. In Sweden and France, this strategy was dominant with estimated cost savings of euro 111 and euro 367, respectively. In Germany, clopidogrel treatment had an incremental cost-effectiveness ratio (ICER) of euro 92/LYG. Data from the COMMIT study showed that clopidogrel treatment resulted in 0.194 LYG at an incremental cost of euro 538 in Sweden, euro 798 in Germany, and euro 545 in France. The corresponding ICERs were euro 2772/LYG, euro 4144/LYG, and euro 2786/LYG, respectively.
Conclusions:
Treatment of these STEMI patients with clopidogrel appeared to be cost-effective in all 3 European countries studied. Predicted ICERs were below generally accepted threshold values.
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