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 pounds. For the 1-year treatment option both trials have ICERs below 4000 pounds. 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. Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.
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 pounds. For the 1-year treatment option both trials have ICERs below 4000 pounds. 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. Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.