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

作者：Karnon Jonathan^*; Holmes Mike W; Williams Robert; Bakhai Ameet; Brennan Alan

来源：International Journal of Cardiology, 2010, 140(3): 315-322.

DOI：10.1016/j.ijcard.2008.11.105

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

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 ST elevation 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 pound. For the 1-year treatment option both trials have ICERs below 4000 pound. 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.

• 出版日期2010-4-30