Document Detail


Cost-effectiveness analysis of short-term clopidogrel therapy for ST elevation myocardial infarction.
MedLine Citation:
PMID:  20215905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clopidogrel improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and is recommended in the guidelines. We sought to determine the incremental cost-effectiveness of clopidogrel therapy in this patient population. We used primary patient-level resource use and clinical outcomes data from 3491 STEMI patients treated with fibrinolysis and either clopidogrel or placebo prior to a diagnostic coronary angiogram in the Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction 28 (CLARITY-TIMI 28) trial. Costs for each patient were calculated based on diagnosis-related groups-specific Medicare reimbursement rates for all hospitalizations and the average wholesale price of clopidogrel. Cost per event prevented and cost per life year gained (LYG) were calculated using standard methods. The estimate of LYG due to clopidogrel therapy was based on recurrent myocardial infarction and death outcomes. The bootstrap method was used to produce bias-corrected confidence intervals for cost and efficacy estimates as well as the cost per LYG ratio. Total costs and resource use were not significantly different for the clopidogrel and placebo groups ($8128 vs. $8134), indicating that short-term clopidogrel therapy is an economically dominant treatment strategy. Even in a sensitivity analysis accounting for higher long-term medical costs due to greater life expectancy, clopidogrel remained under $6000 per LYG. Clopidogrel therapy was dominant in 35% of the bootstrap simulations and cost less than $50,000 per LYG in 67% of simulations. In conclusion, this analysis finds short-term clopidogrel therapy to be a highly economically attractive therapy, improving patient outcomes at no increase in costs.
Authors:
Kyle B Gibler; Haiden A Huskamp; Marc S Sabatine; Sabina A Murphy; David J Cohen; Christopher P Cannon
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical pathways in cardiology     Volume:  9     ISSN:  1535-2811     ISO Abbreviation:  Crit Pathw Cardiol     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-10     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101165286     Medline TA:  Crit Pathw Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  14-8     Citation Subset:  IM    
Affiliation:
Department of Economics, Harvard University, Cambridge, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cost-Benefit Analysis
Diagnosis-Related Groups / economics
Female
Hospital Costs
Humans
Male
Medicare / economics
Middle Aged
Multicenter Studies as Topic
Myocardial Infarction / drug therapy*,  economics*
Platelet Aggregation Inhibitors / economics*,  therapeutic use*
Randomized Controlled Trials as Topic
Recurrence
Thrombolytic Therapy / economics
Ticlopidine / analogs & derivatives*,  economics,  therapeutic use
United States
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

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


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