Using clopidogrel in non-ST-segment elevation acute coronary syndrome patients:: A cost-utility analysis in spain

Objective: The objective of this study was to estimate the cost-effectiveness of clopidogrel, administered for 1 year after hospital admission for non-ST-segment elevation acute coronary syndrome in the Spanish public health network. Methods: A cost-utility analysis was conducted from the societal perspective. A Markov decision tree was constructed for modeling the long-term cardiovascular events according to the probabilities of the CURE study, the Framingham study, and the Spanish age-sex-specific mortality rates. The costs of the therapy were calculated mainly using the cost per diagnosis-related group in the Spanish National Health System. The utilities of the various states were estimated using data from published studies. A 3% discount rate was used for both the costs and the utilities. An expected value sensitivity analysis and a Monte Carlo microsimulation probabilistic analysis were performed. Results: The cost per quality-adjusted life-year (QALY) saved owing to clopidogrel in the base case was about 12,000. This expected cost-effectiveness ratio was very sensitive to the age of the patient, the base risk of cardiovascular events, and the precision of the estimated ef-fectiveness of clopidogrel. The cost per QALY ranged between some 5,000 for a high-risk, 40-year-old patient and 30,000 for a low-risk, 80-year-old patient. According to the accepted threshold for Spanish society, the probability that clopidogrel was cost-effective in the base analysis case was 85.3%. Conclusions: By Spanish standards, the use of clopidogrel in patients with non-ST-segment elevation acute coronary syndrome is cost-effective, at least when used for patients at high risk of presenting cardiovascular events.