Abstract | OBJECTIVES: 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:
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Authors | William S Weintraub, Elizabeth M Mahoney, Andre Lamy, Steven Culler, Yong Yuan, Jaime Caro, Sylvie Gabriel, Salim Yusuf, CURE Study Investigators |
Journal | Journal 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 |
PMID | 15766816
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
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Chemical References |
- Platelet Aggregation Inhibitors
- Clopidogrel
- Ticlopidine
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Topics |
- Acute Disease
- Aged
- Clopidogrel
- 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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