A cost-utility analysis of clopidogrel in patients with ST elevation acute coronary syndromes in the UK

Jonathan Karnon, Mike W. Holmes, Robert Williams, Ameet Bakhai, Alan Brennan

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Objective: To assess the long-term cost effectiveness of treatment for 1 month, and for 1 year with clopidogrel in addition to standard therapy (including aspirin) compared with standard therapy alone, in patients diagnosed with STelevation acute myocardial infarction (STEMI) in the UK. Design: Cost utility analysis using a cohort Markov model, incorporating clinical data from two pivotal clinical trials (the COMMIT/CCS-2 and CLARITY-TIMI 28 trials) and data from UK and non-UK observational studies. Setting: Health economic evaluation carried out from the perspective of the UK NHS. Patients: A representative cohort of 1000 UK patients aged 60 years, diagnosed with STEMI. Interventions: 75 mg/day clopidogrel, with and without a 300 mg loading dose, in addition to standard therapy (including aspirin, 75- 325 mg/day) for 1 month, and for 1 year, followed by standard therapy alone for their remaining lifetime, or standard therapy alone (including aspirin, 75-325 mg/day) for their remaining lifetime. Main outcome measures: Incremental cost per quality-adjusted life-year (QALY) gained (ICER). Results: For the 1-month treatment option both the COMMIT/CCS-2 and CLARITY-TIMI 28 trials have ICERs below £2500. For the 1-year treatment option both trials have ICERs below £4000. Extensive univariate and probabilistic sensitivity analyses showed these results to be robust. Conclusions: In combination with previous economic analyses of clopidogrel in NSTEMI patients, this paper demonstrates that clopidogrel appears to offer a cost-effective treatment option for all ACS patients.

Original languageEnglish
Pages (from-to)315-322
Number of pages8
JournalInternational Journal of Cardiology
Volume140
Issue number3
DOIs
Publication statusPublished - 30 Apr 2010
Externally publishedYes

Keywords

  • myocardial infarction
  • cost utility analysis
  • Markov model
  • Aspirin
  • QALYs
  • ST elevation acute myocardial infarction (STEMI)
  • Cost effectiveness
  • Clopidogrel

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