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Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention: Results From the
Doyeon Hwang1, Hea-Lim Kim2,3, Bon-Kwon Koo1
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
Insights
Clopidogrel monotherapy after percutaneous coronary intervention (PCI) may reduce costs in the UK and US but leads to fewer quality-adjusted life-years (QALYs) compared to aspirin, influenced by cardiovascular mortality rates.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Clinical Trials
Background:
- The HOST-EXAM trial demonstrated clopidogrel monotherapy's superior efficacy and safety over aspirin monotherapy in the chronic maintenance phase post-percutaneous coronary intervention (PCI).
- This study evaluates the economic implications and comparative effectiveness of these antiplatelet strategies.
Purpose of the Study:
- To assess the cost-effectiveness of clopidogrel monotherapy versus aspirin monotherapy for patients after PCI.
- To analyze lifetime healthcare costs and quality-adjusted life-years (QALYs) from multiple healthcare system perspectives.
Main Methods:
- A Markov model was utilized for patients in the stable phase post-PCI.
- Data from the HOST-EXAM trial informed transition probabilities, while country-specific data and literature provided costs and utilities for South Korean, UK, and U.S. healthcare systems.
Main Results:
- In South Korea, clopidogrel monotherapy incurred higher costs ($3,192) and fewer QALYs (0.139) compared to aspirin, linked to slightly higher cardiovascular mortality.
- Conversely, in the UK and U.S., clopidogrel monotherapy was projected to reduce costs (£1,122 and $8,920, respectively) while also reducing QALYs (0.103 and 0.175).
Conclusions:
- Clopidogrel monotherapy may result in reduced QALYs compared to aspirin post-PCI, as suggested by HOST-EXAM trial data.
- This outcome is influenced by a numerically higher cardiovascular mortality rate observed with clopidogrel monotherapy in the trial.
Background:
The HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Disease-Extended Antiplatelet Monotherapy) trial showed superior efficacy and safety of clopidogrel monotherapy compared with aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention (PCI).
Objectives:
The goal of this study was to investigate the cost-effectiveness of clopidogrel monotherapy compared with that of aspirin monotherapy.
Methods:
A Markov model was developed for patients in the stable phase after PCI. From the perspectives of the South Korean, UK, and U.S. health care systems, the lifetime health care costs and quality-adjusted life-years (QALYs) of each strategy were estimated. Transition probabilities were obtained from the HOST-EXAM trial, and health care costs and health-related utilities were obtained from data and literature for each country.
Results:
From the perspective of the South Korean health care system, the base-case analysis showed that clopidogrel monotherapy was $3,192 higher in lifetime health care costs and 0.139 lower in QALYs compared with aspirin. This result was greatly influenced by the numerically but insignificantly higher cardiovascular mortality of clopidogrel compared with aspirin. In the analogous UK and U.S. models, clopidogrel monotherapy was projected to decrease health care costs by £1,122 and $8,920 per patient compared with aspirin monotherapy while reducing QALYs by 0.103 and 0.175, respectively.
Conclusions:
Based on empirical data from the HOST-EXAM trial, clopidogrel monotherapy was projected to lead to reduced QALYs compared with aspirin during the chronic maintenance period after PCI. These results were affected by a numerically higher rate of cardiovascular mortality in clopidogrel monotherapy reported from the HOST-EXAM trial. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250).
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