Long-term cost-effectiveness of clopidogrel given for up to one year in patients with acute coronary syndromes without ST-segment elevation

OBJECTIVES We sought to evaluate the long-term cost-effectiveness 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. (c) 2005 by the American College of Cardiology Foundation.