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Economic evaluation of clopidogrel in acute coronary syndrome patients without ST-segment elevation in Greece: a
Georgia Kourlaba1, Vassilis Fragoulakis, Nikos Maniadakis
1National School of Public Health, Department of Health Services Management, Athens, Greece. kurlaba@hua.gr
Insights
Adding clopidogrel to aspirin therapy for secondary prevention in non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) patients is cost-effective. This combination therapy offers improved outcomes and is a valuable treatment option in Greece.
Area of Science:
- Cardiology
- Health Economics
- Pharmacoeconomics
Background:
- Current guidelines recommend antiplatelet and anticoagulant therapy for secondary prevention in non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA).
- The CURE trial demonstrated clopidogrel plus aspirin is more effective than aspirin alone in reducing atherothrombotic events.
- Evaluating long-term economic costs alongside treatment effectiveness is crucial for optimal patient care, especially under financial constraints.
Purpose of the Study:
- To assess the cost-effectiveness of one-year treatment with clopidogrel plus aspirin for NSTEMI or UA patients.
- The study perspective is that of a third-party payer within the Greek healthcare system.
Main Methods:
- An adapted Markov model with six health states (NSTEMI/UA/no event, stroke, history of stroke, MI, history of MI, death) was utilized.
- Quality-adjusted life-years (QALYs) were estimated using utility values from a Greek national study.
- Costs included antiplatelet therapy, adverse event management, concomitant medications, hospitalizations, outpatient visits, rehabilitation, and nursing.
Main Results:
- Aspirin plus clopidogrel resulted in a discounted survival of 8.41 years and 7.00 QALYs, compared to 8.27 years and 6.88 QALYs for aspirin alone.
- The incremental cost-effectiveness ratio (ICER) for adding clopidogrel was €2,951 per life-year (LY) gained and €3,541 per QALY gained.
- Clopidogrel plus aspirin was cost-effective in over 95% of simulations at a threshold of €7,000 per discounted QALY gained.
Conclusions:
- One-year treatment with clopidogrel in addition to aspirin is a cost-effective strategy for secondary prevention in NSTEMI/UA patients in Greece.
- This combination therapy represents a valuable and economically viable option for improving patient outcomes in acute coronary syndromes without ST-segment elevation.
Background:
Current guidelines recommend treatment with antiplatelet and anticoagulant therapy for the secondary prevention of atherothrombotic events among patients with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina (UA). The CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) trial has shown that clopidogrel alone or in combination with aspirin is more effective in reducing the risk of atherothrombotic events than aspirin alone in NSTEMI or UA patients. However, in the current climate of financial constraints, the effectiveness of a treatment should be considered in conjunction with its long-term economic costs to determine the best possible care.
Objective:
To evaluate the cost effectiveness of 1 year of treatment with clopidogrel in addition to aspirin in NSTEMI or UA patients from the third-party-payer perspective in Greece.
Methods:
An existing Markov model consisting of six states (NSTEMI/UA/no event, first year with stroke, history of stroke, first year with myocardial infarction [MI], history of MI and death) was adapted and extended to the Greek healthcare setting for year 2012. Utility values obtained from a Greek national study were assigned to each health state in order to estimate the quality-adjusted life-years (QALYs). Costs assigned to each health state included antiplatelet treatment cost, cost for the management of adverse events and the costs for concomitant medication, hospitalization, outpatient visits, rehabilitation and nursing. Cost effectiveness and cost utility was expressed as the cost per life-year (LY) gained and QALY gained, respectively. A probabilistic sensitivity analysis was conducted.
Results:
The Markov analysis predicts a discounted survival of 8.27 years in the aspirin treatment group and 8.41 years in the aspirin plus clopidogrel treatment group. The corresponding discounted QALYs were 6.88 and 7.00, respectively. The cumulated lifetime costs per patient were € 18 779 and € 19 191, for the aspirin and aspirin plus clopidogrel treatment arms, respectively. The incremental cost-effectiveness ratio (ICER) with the addition of clopidogrel was &U20AC;2951 for each LY saved and &U20AC;3541 for each QALY saved. Finally, clopidogrel plus aspirin was found to be cost effective in more than 95% of simulated samples at a threshold of &U20AC;7000 per discounted QALY gained.
Conclusion:
One-year treatment with clopidogrel in addition to aspirin is a cost-effective treatment option for secondary prevention in patients with acute coronary syndrome without ST-segment elevation in Greece.
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