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The long-term cost-effectiveness of clopidogrel plus aspirin in patients undergoing percutaneous coronary intervention in Sweden.
Clin Ther. 2005 Jan; 27(1):100-10.CT

Abstract

BACKGROUND

The Percutaneous Coronary Intervention-Clopidogrel in Unstable Angina to Prevent Recurrent Events (PCI-CURE) study, which examined the effect of adding clopidogrel to aspirin versus aspirin alone in patients with unstable coronary artery disease (CAD) undergoing PCI, found a relative risk reduction in cardiovascular deaths and myocardial infarction among those treated with clopidogrel. In addition, a within-trial cost-effectiveness analysis showed favorable costs per event avoided. However, to estimate the long-term effects, a modeling approach is necessary.

OBJECTIVES

The purpose of this study was to estimate the long-term cost-effectiveness of treating patients undergoing PCI with clopidogrel plus aspirin in Sweden.

METHODS

A Markov model was developed. Transition probabilities were estimated based on a register of patients treated in the coronary care units at 74 (out of 78) hospitals throughout Sweden. Patients were assumed to be treated for 1 year with an effect based on data from the PCI-CURE study. Costs were collected from published sources and recalculated to year-2004 Euros (Euro 1.00 = USD 1.24). Life-years gained were used as the measure of effectiveness. The perspective was that of the Swedish society, with a separate analysis using a health care cost perspective.

RESULTS

After inclusion and exclusion criteria were applied, 3474 patients were included in the model analysis. The model predicted a net gain in survival of 0.04 year per patient when adding clopidogrel. This yielded a net increase of Euros 449 if only direct costs were included; with indirect costs, the net increase was Euros 332. The resulting cost-effectiveness ratios were Euros 10,993 and Euros 8127 per life-year gained.

CONCLUSIONS

The predicted cost-effectiveness ratios were well below the threshold values generally considered cost-effective. Adding clopidogrel to aspirin appeared to be cost-effective in this model analysis of patients with unstable CAD undergoing PCI in Sweden.

Authors+Show Affiliations

Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. peter.lindgren@imm.ki.seNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15763611

Citation

Lindgren, Peter, et al. "The Long-term Cost-effectiveness of Clopidogrel Plus Aspirin in Patients Undergoing Percutaneous Coronary Intervention in Sweden." Clinical Therapeutics, vol. 27, no. 1, 2005, pp. 100-10.
Lindgren P, Stenestrand U, Malmberg K, et al. The long-term cost-effectiveness of clopidogrel plus aspirin in patients undergoing percutaneous coronary intervention in Sweden. Clin Ther. 2005;27(1):100-10.
Lindgren, P., Stenestrand, U., Malmberg, K., & Jönsson, B. (2005). The long-term cost-effectiveness of clopidogrel plus aspirin in patients undergoing percutaneous coronary intervention in Sweden. Clinical Therapeutics, 27(1), 100-10.
Lindgren P, et al. The Long-term Cost-effectiveness of Clopidogrel Plus Aspirin in Patients Undergoing Percutaneous Coronary Intervention in Sweden. Clin Ther. 2005;27(1):100-10. PubMed PMID: 15763611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The long-term cost-effectiveness of clopidogrel plus aspirin in patients undergoing percutaneous coronary intervention in Sweden. AU - Lindgren,Peter, AU - Stenestrand,Ulf, AU - Malmberg,Klas, AU - Jönsson,Bengt, PY - 2004/11/22/accepted PY - 2005/3/15/pubmed PY - 2005/4/12/medline PY - 2005/3/15/entrez SP - 100 EP - 10 JF - Clinical therapeutics JO - Clin Ther VL - 27 IS - 1 N2 - BACKGROUND: The Percutaneous Coronary Intervention-Clopidogrel in Unstable Angina to Prevent Recurrent Events (PCI-CURE) study, which examined the effect of adding clopidogrel to aspirin versus aspirin alone in patients with unstable coronary artery disease (CAD) undergoing PCI, found a relative risk reduction in cardiovascular deaths and myocardial infarction among those treated with clopidogrel. In addition, a within-trial cost-effectiveness analysis showed favorable costs per event avoided. However, to estimate the long-term effects, a modeling approach is necessary. OBJECTIVES: The purpose of this study was to estimate the long-term cost-effectiveness of treating patients undergoing PCI with clopidogrel plus aspirin in Sweden. METHODS: A Markov model was developed. Transition probabilities were estimated based on a register of patients treated in the coronary care units at 74 (out of 78) hospitals throughout Sweden. Patients were assumed to be treated for 1 year with an effect based on data from the PCI-CURE study. Costs were collected from published sources and recalculated to year-2004 Euros (Euro 1.00 = USD 1.24). Life-years gained were used as the measure of effectiveness. The perspective was that of the Swedish society, with a separate analysis using a health care cost perspective. RESULTS: After inclusion and exclusion criteria were applied, 3474 patients were included in the model analysis. The model predicted a net gain in survival of 0.04 year per patient when adding clopidogrel. This yielded a net increase of Euros 449 if only direct costs were included; with indirect costs, the net increase was Euros 332. The resulting cost-effectiveness ratios were Euros 10,993 and Euros 8127 per life-year gained. CONCLUSIONS: The predicted cost-effectiveness ratios were well below the threshold values generally considered cost-effective. Adding clopidogrel to aspirin appeared to be cost-effective in this model analysis of patients with unstable CAD undergoing PCI in Sweden. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/15763611/The_long_term_cost_effectiveness_of_clopidogrel_plus_aspirin_in_patients_undergoing_percutaneous_coronary_intervention_in_Sweden_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(05)00009-3 DB - PRIME DP - Unbound Medicine ER -