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Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease.
N Engl J Med. 2002 Jun 06; 346(23):1800-6.NEJM

Abstract

BACKGROUND

Both aspirin and clopidogrel reduce the rate of cardiovascular events in patients with coronary heart disease. We estimated the cost effectiveness of the increased use of aspirin, clopidogrel, or both for secondary prevention in patients with coronary heart disease.

METHODS

We used the Coronary Heart Disease Policy Model, a computer simulation of the U.S. population, to estimate the incremental cost effectiveness (in dollars per quality-adjusted years of life gained) of four strategies in patients over 35 years of age with coronary disease from 2003 to 2027: aspirin for all eligible patients (i.e., those who were not allergic to or intolerant of aspirin), aspirin for all eligible patients plus clopidogrel for patients who were ineligible for aspirin, clopidogrel for all patients, and the combination of aspirin for all eligible patients plus clopidogrel for all patients.

RESULTS

The extension of aspirin therapy from the current levels of use to all eligible patients for 25 years would have an estimated cost-effectiveness ratio of about $11,000 per quality-adjusted year of life gained. The addition of clopidogrel for the 5 percent of patients who are ineligible for aspirin would cost about $31,000 per quality-adjusted year of life gained. Clopidogrel alone in all patients or in routine combination with aspirin had an incremental cost of more than $130,000 per quality-adjusted year of life gained and remained financially unattractive across a wide range of assumptions. However, clopidogrel alone or in combination with aspirin would cost less than $50,000 per quality-adjusted year of life gained if its price were reduced by 70 to 82 percent, to $1.00 and $0.60 per day, respectively.

CONCLUSIONS

Increased prescription of aspirin for secondary prevention of coronary heart disease is attractive from a cost-effectiveness perspective. Because clopidogrel is more costly, its incremental cost effectiveness is currently unattractive, unless its use is restricted to patients who are ineligible for aspirin.

Authors+Show Affiliations

Clinique de Médecine II and the Division of Cardiology, Hôpitaux Universitaires, Geneva, Switzerland. jean-michel.gaspoz@hcuge.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12050341

Citation

Gaspoz, Jean-Michel, et al. "Cost Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart Disease." The New England Journal of Medicine, vol. 346, no. 23, 2002, pp. 1800-6.
Gaspoz JM, Coxson PG, Goldman PA, et al. Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. N Engl J Med. 2002;346(23):1800-6.
Gaspoz, J. M., Coxson, P. G., Goldman, P. A., Williams, L. W., Kuntz, K. M., Hunink, M. G., & Goldman, L. (2002). Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. The New England Journal of Medicine, 346(23), 1800-6.
Gaspoz JM, et al. Cost Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart Disease. N Engl J Med. 2002 Jun 6;346(23):1800-6. PubMed PMID: 12050341.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. AU - Gaspoz,Jean-Michel, AU - Coxson,Pamela G, AU - Goldman,Paula A, AU - Williams,Lawrence W, AU - Kuntz,Karen M, AU - Hunink,M G Myriam, AU - Goldman,Lee, PY - 2002/6/7/pubmed PY - 2002/6/12/medline PY - 2002/6/7/entrez SP - 1800 EP - 6 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 346 IS - 23 N2 - BACKGROUND: Both aspirin and clopidogrel reduce the rate of cardiovascular events in patients with coronary heart disease. We estimated the cost effectiveness of the increased use of aspirin, clopidogrel, or both for secondary prevention in patients with coronary heart disease. METHODS: We used the Coronary Heart Disease Policy Model, a computer simulation of the U.S. population, to estimate the incremental cost effectiveness (in dollars per quality-adjusted years of life gained) of four strategies in patients over 35 years of age with coronary disease from 2003 to 2027: aspirin for all eligible patients (i.e., those who were not allergic to or intolerant of aspirin), aspirin for all eligible patients plus clopidogrel for patients who were ineligible for aspirin, clopidogrel for all patients, and the combination of aspirin for all eligible patients plus clopidogrel for all patients. RESULTS: The extension of aspirin therapy from the current levels of use to all eligible patients for 25 years would have an estimated cost-effectiveness ratio of about $11,000 per quality-adjusted year of life gained. The addition of clopidogrel for the 5 percent of patients who are ineligible for aspirin would cost about $31,000 per quality-adjusted year of life gained. Clopidogrel alone in all patients or in routine combination with aspirin had an incremental cost of more than $130,000 per quality-adjusted year of life gained and remained financially unattractive across a wide range of assumptions. However, clopidogrel alone or in combination with aspirin would cost less than $50,000 per quality-adjusted year of life gained if its price were reduced by 70 to 82 percent, to $1.00 and $0.60 per day, respectively. CONCLUSIONS: Increased prescription of aspirin for secondary prevention of coronary heart disease is attractive from a cost-effectiveness perspective. Because clopidogrel is more costly, its incremental cost effectiveness is currently unattractive, unless its use is restricted to patients who are ineligible for aspirin. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/12050341/Cost_effectiveness_of_aspirin_clopidogrel_or_both_for_secondary_prevention_of_coronary_heart_disease_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM200206063462309?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -