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

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.