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Cost-effectiveness of clopidogrel in acute coronary syndromes in Canada: a long-term analysis based on the CURE trial
Paul Kolm1, Yong Yuan, Emir Veledar
1Christiana Care Health System, Newark, Delaware, USA. pkolm@christiancare.org
Insights
Clopidogrel combined with aspirin is a cost-effective antiplatelet therapy for cardiovascular events in Canada. This strategy offers significant value, preventing events and improving life-years gained within the healthcare system.
Area of Science:
- Health Economics
- Cardiology
- Pharmacoeconomics
Background:
- Cardiovascular diseases represent a significant burden on Canadian healthcare, accounting for nearly 20% of hospitalizations and 12% of total illness costs.
- Rising cardiovascular disease trends and associated care costs necessitate the development of cost-effective management strategies.
- The CURE and PCI-CURE trials established the efficacy of clopidogrel plus acetylsalicylic acid (ASA) in reducing cardiovascular events.
Purpose of the Study:
- To evaluate the cost-effectiveness of clopidogrel within the Canadian healthcare system.
- To compare the economic value of clopidogrel combination therapy against ASA alone and other cardiovascular treatments.
Main Methods:
- Hospitalization costs were estimated using 2003 Alberta Health and Wellness cost schedules and Case Mix Group classifications.
- Life expectancy data were sourced from the Saskatchewan Health Database to extend beyond trial duration.
- Cost-effectiveness was quantified using incremental cost-effectiveness ratios (ICERs) and bootstrap analysis for cost and effectiveness distributions.
Main Results:
- Clopidogrel demonstrated cost-effectiveness, with ICERs below $10,000 per event prevented and $4,000 per life-year gained.
- The probability of achieving a cost per life-year gained below $20,000 was high: 0.975 for CURE patients and 0.904 for PCI-CURE patients.
- Economic analysis confirmed clopidogrel combination therapy's cost-effectiveness compared to ASA alone.
Conclusions:
- Clopidogrel combination therapy is a cost-effective antiplatelet strategy in the Canadian healthcare context.
- The therapy provides economic value not only against ASA but also when compared to other standard cardiovascular treatments.
- The findings support the integration of clopidogrel combination therapy as an economically viable option for managing acute coronary syndromes.
Background:
Cardiovascular diseases account for nearly 20% of all hospitalizations in Canada and consume 12% of the total cost of all illnesses. With increasing trends of cardiovascular disease and increasing costs of care, development of cost-effective strategies is vital. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial demonstrated the effectiveness of clopidogrel plus acetylsalicylic acid (ASA) compared with ASA alone in reducing cardiovascular events in patients with acute coronary syndromes and, in addition, patients undergoing percutaneous coronary intervention in the Percutaneous Coronary Intervention in CURE (PCI-CURE) trial.
Objective:
To assess the cost-effectiveness of clopidogrel in the Canadian health care system.
Methods:
Estimates of hospitalization costs were based on the 2003 cost schedules released by the Health Funding and Costing Branch of the Alberta Health and Wellness, as well as on the Case Mix Group classification system. Life expectancy beyond the trial was estimated from the Saskatchewan Health Database. Cost-effectiveness was expressed as the incremental cost-effectiveness ratio, and bootstrap methods were used to estimate the joint distribution of costs and effectiveness.
Results:
Clopidogrel was shown to be cost-effective, with incremental cost-effectiveness ratios less than $10,000 per event prevented and less than $4,000 per life-year gained. The probability of clopidogrel resulting in cost per life-year gained of less than $20,000 was 0.975 for CURE patients and 0.904 for PCI-CURE patients.
Conclusions:
The economic analysis demonstrated that clopidogrel combination therapy is not only cost-effective as antiplatelet therapy compared with ASA alone, but it is also cost-effective compared with other commonly used and openly reimbursed cardiovascular therapies in the Canadian health care system.
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