Document Detail


Clopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost-effectiveness analysis.
MedLine Citation:
PMID:  15178495     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Clopidogrel is more effective than aspirin in preventing recurrent vascular events, but concerns about its cost-effectiveness have limited its use. We evaluated the cost-effectiveness of clopidogrel and aspirin as secondary prevention in patients with a prior myocardial infarction, a prior stroke, or peripheral arterial disease. METHODS: We constructed Markov models assuming a societal perspective, and based analyses on the lifetime treatment of a 63-year-old patient facing event probabilities derived from the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial as the base case. Outcome measures included costs, life expectancy in quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and events averted. RESULTS: In patients with peripheral arterial disease, clopidogrel increased life expectancy by 0.55 QALYs at an incremental cost-effectiveness ratio of $25,100 per QALY, as compared with aspirin. In poststroke patients, clopidogrel increased life expectancy by 0.17 QALYs at a cost of $31,200 per QALY. Aspirin was both less expensive and more effective than clopidogrel in post-myocardial infarction patients. In probabilistic sensitivity analyses, our evaluation for patients with peripheral vascular disease was robust. Evaluations of stroke and myocardial infarction patients were sensitive predominantly to the cost and efficacy of clopidogrel, with aspirin therapy more effective and less expensive in 153 of 1000 simulations (15.3%) in poststroke patients and clopidogrel more effective in 119 of 1000 simulations (11.9%) in the myocardial infarction sample. CONCLUSION: Clopidogrel provides a substantial increase in quality-adjusted life expectancy at a cost that is within traditional societal limits for patients with either peripheral arterial disease or a recent stroke. Current evidence does not support increased efficacy with clopidogrel relative to aspirin in patients following myocardial infarction.
Authors:
Mark D Schleinitz; J Peter Weiss; Douglas K Owens
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of medicine     Volume:  116     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-04     Completed Date:  2004-08-09     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  797-806     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine (JPW), Stanford University, Palo Alto, California, USA. Mark_Schleinitz@Brown.edu
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MeSH Terms
Descriptor/Qualifier:
Aspirin / economics*,  therapeutic use*
Cost-Benefit Analysis
Fibrinolytic Agents / economics*,  therapeutic use*
Humans
Markov Chains
Middle Aged
Platelet Aggregation Inhibitors / economics*,  therapeutic use*
Sensitivity and Specificity
Ticlopidine / analogs & derivatives*,  economics*,  therapeutic use*
Vascular Diseases / prevention & control*
Grant Support
ID/Acronym/Agency:
HD43447/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Comments/Corrections
Comment In:
Am J Med. 2005 Feb;118(2):198-9; author reply 199   [PMID:  15694909 ]
Am J Med. 2005 Feb;118(2):199-200; author reply 200   [PMID:  15694910 ]
Am J Med. 2004 Jun 15;116(12):850-2   [PMID:  15178502 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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