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Clopidogrel versus aspirin in patients with atherothrombosis: CAPRIE-based calculation of cost-effectiveness for

K Berger1, F Hessel, J Kreuzer

  • 1University Hospital Munich, Department of Hemostaseology and Transfusion Medicine, Economic Working Group, Ziemssenstrasse 1, D-80336 Munich, Germany. Karin.Berger@med.uni-muenchen.de

Current Medical Research and Opinion
|December 7, 2007
PubMed

Insights

Clopidogrel significantly reduces vascular events and deaths compared to aspirin (acetylsalicylic acid) in German patients with cardiovascular conditions. The cost per life-year saved is estimated between €14,380 and €18,790, considered acceptable for German payers.

Area of Science:

  • Pharmacoeconomics
  • Cardiovascular Medicine
  • Health Technology Assessment

Background:

  • Secondary prevention of atherothrombotic events is crucial for patients with myocardial infarction (MI), ischaemic stroke (IS), or peripheral arterial disease (PAD).
  • Comparing the cost-effectiveness of clopidogrel versus aspirin (acetylsalicylic acid) (ASS) is essential for healthcare resource allocation in Germany.

Purpose of the Study:

  • To model the 2-year cost-effectiveness of clopidogrel compared to ASS for secondary prevention in German patients with MI, IS, or PAD.
  • To evaluate the cost per life-year saved (LYS) from the perspective of German third-party payers (TPP).

Main Methods:

  • An existing Markov model was adapted to the German healthcare setting using German cost data.
  • The model incorporated cardiovascular event survival times from Framingham and Saskatchewan health databases in separate scenarios.
  • Data from the CAPRIE trial formed the basis for the cost-effectiveness analysis.

Main Results:

  • Clopidogrel treatment resulted in 13.19 fewer vascular events per 1000 patients, including 2.21 fewer vascular deaths.
  • The incremental costs for 2-year management with clopidogrel were approximately €1,241,440 per 1000 patients.
  • Incremental costs per life-year saved were €14,380 (Framingham data) and €18,790 (Saskatchewan data).

Conclusions:

  • The cost-effectiveness of clopidogrel in Germany aligns with findings from Belgium, Italy, and France.
  • Incremental cost-effectiveness ratios below €20,000 per LYS are likely acceptable to German third-party payers.
  • Clopidogrel represents a potentially cost-effective secondary prevention strategy for atherothrombotic diseases in Germany.
Abstract

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