OBJECTIVES: We sought to evaluate the long-term costeffectiveness of clopidogrel for up to one year after an acute coronary syndrome(ACS) without ST-segment elevation. BACKGROUND: The efficacy of platelet inhibition w...OBJECTIVES: We sought to evaluate the long-term costeffectiveness of clopidogrel for up to one year after an acute coronary syndrome(ACS) without ST-segment elevation. BACKGROUND: The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events(CURE) trial, a randomized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000. Patients were given clopidogrel(300-mg load followed by 75 mg/day) versus placebo, both in addition to aspirin, for a mean of nine months. METHODS: We used patient-level clinical outcomes and resource use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death, stroke, and myocardial infarction on the basis of data from external sources. RESULTS: Excluding clopidogrel costs, average costs of hospitalizations alone were ＄325 less for the clopidogrel arm(95%confidence interval -＄722 to ＄45) using diagnosis-related group-based Medicare reimbursement rates. When including clopidogrel costs(＄766 greater for the clopidogrel arm), average total costs were ＄442 higher for the clopidogrel arm(95%confidence interval ＄62 to ＄820). The incremental cost-effectiveness ratio(ICER) on the basis of the Framingham Heart Study was ＄6,318 per life-year gained(LYG) with clopidogrel, with 94%of bootstrap-derived ICER estimates <＄50,000/ LYG; based on Saskatchewan, the ICER was ＄6,475/LYG with 98%of estimates <＄50,000. CONCLUSIONS: Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective.展开更多
文摘OBJECTIVES: We sought to evaluate the long-term costeffectiveness of clopidogrel for up to one year after an acute coronary syndrome(ACS) without ST-segment elevation. BACKGROUND: The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events(CURE) trial, a randomized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000. Patients were given clopidogrel(300-mg load followed by 75 mg/day) versus placebo, both in addition to aspirin, for a mean of nine months. METHODS: We used patient-level clinical outcomes and resource use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death, stroke, and myocardial infarction on the basis of data from external sources. RESULTS: Excluding clopidogrel costs, average costs of hospitalizations alone were ＄325 less for the clopidogrel arm(95%confidence interval -＄722 to ＄45) using diagnosis-related group-based Medicare reimbursement rates. When including clopidogrel costs(＄766 greater for the clopidogrel arm), average total costs were ＄442 higher for the clopidogrel arm(95%confidence interval ＄62 to ＄820). The incremental cost-effectiveness ratio(ICER) on the basis of the Framingham Heart Study was ＄6,318 per life-year gained(LYG) with clopidogrel, with 94%of bootstrap-derived ICER estimates <＄50,000/ LYG; based on Saskatchewan, the ICER was ＄6,475/LYG with 98%of estimates <＄50,000. CONCLUSIONS: Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective.
