Elsevier

Clinical Therapeutics

Volume 27, Issue 1, January 2005, Pages 100-110
Clinical Therapeutics

The long-term cost-effectiveness of clopidogrel plus aspirin in patients undergoing percutaneous coronary intervention in Sweden

https://doi.org/10.1016/j.clinthera.2005.01.008Get rights and content

Abstract

Background:

The Percutaneous CoronaryIntervention-Clopidogrel in Unstable Angina to Prevent Recurrent Events (PCI-CURE) study, which examined the effect of adding clopidogrel to aspirin versus aspirin alone in patients with unstable coronary artery disease (CAD) undergoing PCI, found a relative risk reduction in cardiovascular deaths and myocardial infarction among those treated with clopidogrel. In addition, a within-trial cost-effectiveness analysis showed favorable costs per event avoided. However, to estimate the long-term effects, a modeling approach is necessary.

Objectives:

The purpose of this study was to estimatethe long-term cost-effectiveness of treating patients undergoing PCI with clopidogrel plus aspirin in Sweden.

Methods:

A Markov model was developed. Transitionprobabilities were estimated based on a register of patients treated in the coronary care units at 74 (out of 78) hospitals throughout Sweden. Patients were assumed to be treated for 1 year with an effect based on data from the PCI-CURE study. Costs were collected from published sources and recalculated to year-2004 euros (1.00 = US $1.24). Life-years gained were used as the measure of effectiveness. The perspective was that of the Swedish society, with a separate analysis using a health care cost perspective.

Results:

After inclusion and exclusion criteria were applied, 3474 patients were included in the model analysis. The model predicted a net gain in survival of 0.04 year per patient when adding clopidogrel. This yielded a net increase of 449 if only direct costs were included; with indirect costs, the net increase was 332. The resulting cost-effectiveness ratios were ε10,993 and 8127 per life-year gained.

Conclusions:

The predicted cost-effectiveness ratios were well below the threshold values generally considered cost-effective. Adding clopidogrel to aspirin appeared to be cost-effective in this model analysis of patients with unstable CAD undergoing PCI in Sweden.

References (24)

  • SonnenbergF.A. et al.

    Markov models in medical decision making: A practical guide

    Med Decis Making

    (1993)
  • HalpernE.F. et al.

    Representing both first- and second-order uncertainties by Monte Carlo simulation for groups of patients

    Med Decis Making

    (2000)
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