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Long-term cost-effectiveness of clopidogrel given for up to one year in patients with acute coronary syndromes without ST-segment elevation.

AbstractOBJECTIVES:
We sought to evaluate the long-term cost-effectiveness of clopidogrel for up to one year after an acute coronary syndrome (ACS) without ST-segment elevation.
BACKGROUND:
The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, a randomized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000. Patients were given clopidogrel (300-mg load followed by 75 mg/day) versus placebo, both in addition to aspirin, for a mean of nine months.
METHODS:
We used patient-level clinical outcomes and resource use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death, stroke, and myocardial infarction on the basis of data from external sources.
RESULTS:
Excluding clopidogrel costs, average costs of hospitalizations alone were 325 dollars less for the clopidogrel arm (95% confidence interval -722 dollars to 45 dollars) using diagnosis-related group-based Medicare reimbursement rates. When including clopidogrel costs (766 dollars greater for the clopidogrel arm), average total costs were 442 dollars higher for the clopidogrel arm (95% confidence interval 62 dollars to 820 dollars). The incremental cost-effectiveness ratio (ICER) on the basis of the Framingham Heart Study was 6,318 dollars per life-year gained (LYG) with clopidogrel, with 94% of bootstrap-derived ICER estimates <50,000 dollars/LYG; based on Saskatchewan, the ICER was 6,475 dollars/LYG with 98% of estimates <50,000 dollars.
CONCLUSIONS:
Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective.
AuthorsWilliam S Weintraub, Elizabeth M Mahoney, Andre Lamy, Steven Culler, Yong Yuan, Jaime Caro, Sylvie Gabriel, Salim Yusuf,
JournalJournal of the American College of Cardiology (J Am Coll Cardiol) Vol. 45 Issue 6 Pg. 838-45 (Mar 15 2005) ISSN: 0735-1097 [Print] United States
PMID15766816 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
Chemical References
  • Platelet Aggregation Inhibitors
  • clopidogrel
  • Ticlopidine
Topics
  • Acute Disease
  • Aged
  • Coronary Disease (drug therapy, economics, epidemiology)
  • Cost-Benefit Analysis (economics, statistics & numerical data)
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Length of Stay (economics)
  • Life Expectancy
  • Male
  • Medicare (economics)
  • Middle Aged
  • Myocardial Infarction (drug therapy, economics, epidemiology)
  • Patient Admission (economics, statistics & numerical data)
  • Platelet Aggregation Inhibitors (economics, therapeutic use)
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Syndrome
  • Ticlopidine (analogs & derivatives, economics, therapeutic use)
  • Time
  • Treatment Outcome
  • United States (epidemiology)

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