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Cost-effectiveness of clopidogrel in myocardial infarction with ST-segment elevation: a European model based on the CLARITY and COMMIT trials.
Clin Ther. 2007 Jun; 29(6):1184-202.CT

Abstract

BACKGROUND

Several health economic studies have shown that the use of clopidogrel is cost-effective to prevent ischemic events in non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina.

OBJECTIVE

This study was designed to assess the cost-effectiveness of clopidogrel in short- and long-term treatment of ST-segment elevation myocardial infarction (STEMI) with the use of data from 2 trials in Sweden, Germany, and France: CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) and COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial).

METHODS

A combined decision tree and Markov model was constructed. Because existing evidence indicates similar long-term outcomes after STEMI and NSTEMI, data from the long-term NSTEMI CURE trial (Clopidogrel in Unstable Angina to Prevent Recurrent Events) were combined with 1-month data from CLARITY and COMMIT to model the effect of treatment up to 1 year. The risks of death, myocardial infarction, and stroke in an untreated population and long-term survival after all events were derived from the Swedish Hospital Discharge and Cause of Death register. The model was run separately for the 2 STEMI trials. A payer perspective was chosen for the comparative analysis, focusing on direct medical costs. Costs were derived from published sources and were converted to 2005 euros. Effectiveness was measured as the number of life-years gained (LYG) from clopidogrel treatment.

RESULTS

In a patient cohort with the same characteristics and event rates as in the CLARITY population, treatment with clopidogrel for up to 1 year resulted in 0.144 LYG. In Sweden and France, this strategy was dominant with estimated cost savings of euro 111 and euro 367, respectively. In Germany, clopidogrel treatment had an incremental cost-effectiveness ratio (ICER) of euro 92/LYG. Data from the COMMIT study showed that clopidogrel treatment resulted in 0.194 LYG at an incremental cost of euro 538 in Sweden, euro 798 in Germany, and euro 545 in France. The corresponding ICERs were euro 2772/LYG, euro 4144/LYG, and euro 2786/LYG, respectively.

CONCLUSIONS

Treatment of these STEMI patients with clopidogrel appeared to be cost-effective in all 3 European countries studied. Predicted ICERs were below generally accepted threshold values.

Authors+Show Affiliations

European Health Economics, Stockholm, Sweden. jenny.b@healtheconomics.seNo affiliation info availableNo 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

17692733

Citation

Berg, Jenny, et al. "Cost-effectiveness of Clopidogrel in Myocardial Infarction With ST-segment Elevation: a European Model Based On the CLARITY and COMMIT Trials." Clinical Therapeutics, vol. 29, no. 6, 2007, pp. 1184-202.
Berg J, Lindgren P, Spiesser J, et al. Cost-effectiveness of clopidogrel in myocardial infarction with ST-segment elevation: a European model based on the CLARITY and COMMIT trials. Clin Ther. 2007;29(6):1184-202.
Berg, J., Lindgren, P., Spiesser, J., Parry, D., & Jönsson, B. (2007). Cost-effectiveness of clopidogrel in myocardial infarction with ST-segment elevation: a European model based on the CLARITY and COMMIT trials. Clinical Therapeutics, 29(6), 1184-202.
Berg J, et al. Cost-effectiveness of Clopidogrel in Myocardial Infarction With ST-segment Elevation: a European Model Based On the CLARITY and COMMIT Trials. Clin Ther. 2007;29(6):1184-202. PubMed PMID: 17692733.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of clopidogrel in myocardial infarction with ST-segment elevation: a European model based on the CLARITY and COMMIT trials. AU - Berg,Jenny, AU - Lindgren,Peter, AU - Spiesser,Julie, AU - Parry,David, AU - Jönsson,Bengt, PY - 2007/04/07/accepted PY - 2007/8/19/pubmed PY - 2007/9/26/medline PY - 2007/8/19/entrez SP - 1184 EP - 202 JF - Clinical therapeutics JO - Clin Ther VL - 29 IS - 6 N2 - BACKGROUND: Several health economic studies have shown that the use of clopidogrel is cost-effective to prevent ischemic events in non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. OBJECTIVE: This study was designed to assess the cost-effectiveness of clopidogrel in short- and long-term treatment of ST-segment elevation myocardial infarction (STEMI) with the use of data from 2 trials in Sweden, Germany, and France: CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) and COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial). METHODS: A combined decision tree and Markov model was constructed. Because existing evidence indicates similar long-term outcomes after STEMI and NSTEMI, data from the long-term NSTEMI CURE trial (Clopidogrel in Unstable Angina to Prevent Recurrent Events) were combined with 1-month data from CLARITY and COMMIT to model the effect of treatment up to 1 year. The risks of death, myocardial infarction, and stroke in an untreated population and long-term survival after all events were derived from the Swedish Hospital Discharge and Cause of Death register. The model was run separately for the 2 STEMI trials. A payer perspective was chosen for the comparative analysis, focusing on direct medical costs. Costs were derived from published sources and were converted to 2005 euros. Effectiveness was measured as the number of life-years gained (LYG) from clopidogrel treatment. RESULTS: In a patient cohort with the same characteristics and event rates as in the CLARITY population, treatment with clopidogrel for up to 1 year resulted in 0.144 LYG. In Sweden and France, this strategy was dominant with estimated cost savings of euro 111 and euro 367, respectively. In Germany, clopidogrel treatment had an incremental cost-effectiveness ratio (ICER) of euro 92/LYG. Data from the COMMIT study showed that clopidogrel treatment resulted in 0.194 LYG at an incremental cost of euro 538 in Sweden, euro 798 in Germany, and euro 545 in France. The corresponding ICERs were euro 2772/LYG, euro 4144/LYG, and euro 2786/LYG, respectively. CONCLUSIONS: Treatment of these STEMI patients with clopidogrel appeared to be cost-effective in all 3 European countries studied. Predicted ICERs were below generally accepted threshold values. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/17692733/Cost_effectiveness_of_clopidogrel_in_myocardial_infarction_with_ST_segment_elevation:_a_European_model_based_on_the_CLARITY_and_COMMIT_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(07)00179-8 DB - PRIME DP - Unbound Medicine ER -