The cost of clopidogrel use in atrial fibrillation in the ACTIVE-A trial

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Clinical Trial Analysis

Background:

• The ACTIVE-A trial showed clopidogrel plus aspirin (C+A) reduced stroke risk but increased bleeding in atrial fibrillation patients ineligible for vitamin K antagonists (VKAs).
• This study evaluated the economic impact of C+A in this specific patient group.

Purpose of the Study:

• To determine the cost-effectiveness of adding clopidogrel to aspirin therapy for patients with atrial fibrillation who cannot use VKA therapy.
• To analyze the direct healthcare costs associated with C+A versus aspirin alone.

Main Methods:

• Extracted healthcare utilization data, focusing on direct costs and hospitalizations.
• Utilized Canadian unit costs and the Canadian list price for clopidogrel.
• Applied a 3% annual discount rate to costs in 2008 Canadian dollars.

Main Results:

• C+A demonstrated cost savings in healthcare utilization components, excluding the study medication itself.
• Cost savings from stroke prevention effectively balanced the expense of clopidogrel.
• Total costs per patient were $14,132 for C+A versus $13,756 for aspirin alone, an incremental cost of $376, with sensitivity analyses indicating potential cost savings or increases depending on clopidogrel pricing.

Conclusions:

• Combination therapy with clopidogrel and aspirin is cost-neutral for atrial fibrillation patients unsuitable for VKA therapy under the study's conditions.
• The cost of clopidogrel is offset by the prevention of expensive stroke-related healthcare events.
• Findings support the use of C+A in ACTIVE-A patients for whom VKA therapy is not a suitable option.