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Long-Term Clopidogrel Therapy in Patients Receiving Percutaneous Coronary Intervention

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  • Bart Heeg
  • Ron Peters
  • Marc Botteman
  • Ben Hout

Abstract

Background: The PCI-CURE (Percutaneous Coronary Intervention-Clopidogrel in Unstable Angina to Prevent Recurrent Events) and CREDO (Clopidogrel for the Reduction of Events During Observation) studies have demonstrated that, in addition to aspirin, pre-treatment with clopidogrel followed by long-term (i.e. 9—12 months) therapy significantly reduces the risk of atherothrombotic events in patients undergoing percutaneous coronary intervention (PCI). Objective: To examine the economic implications, from the Dutch healthcare perspective, of the use of clopidogrel in patients undergoing PCI (elective procedures or in patients with acute coronary syndrome), comparing pre-treatment followed by long-term therapy with only 4 weeks of treatment. Methods: A lifetime Markov model was used to combine data from the PCI-CURE and CREDO trials with data from the literature concerning epidemiology, costs and quality of life. The model was run separately for each trial. Only direct healthcare costs (€, year 2004 values) were considered. Costs and outcomes were discounted at 4% per anum. For each trial, the cost effectiveness is expressed as costs per life-year and QALY gained. Uncertainties are addressed by uni- and probabilistic multivariate sensitivity analysis. Results: When starting with the data from the PCI-CURE trial, pre-treatment plus 9-month clopidogrel therapy was predicted to save €1119 and gain 0.03 life-years and 0.07 QALYs per patient compared with short-term treatment. When starting with the data from the CREDO trial, the combination of pre-treatment and prolonged clopidogrel therapy (1 year) was estimated to save €497 and gain 0.10 life-years and 0.14 QALYs per patient. Univariate and probabilistic multivariate sensitivity analyses suggested that the conclusions were generally robust, but that the expected gain in survival for the PCI-CURE population was very sensitive to the effects on mortality within the combined endpoint of myocardial infarction/stroke-free survival. Conclusions: In The Netherlands, pre-treatment plus long-term (9–12 months) therapy with clopidogrel is estimated to save costs and increase (quality-adjusted) survival in the prevention of ischaemic events among patients undergoing elective PCI (CREDO) and in patients with acute coronary syndrome (PCI-CURE) compared with short-term treatment with clopidogrel without pre-treatment. Copyright Adis Data Information BV 2007

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  • Bart Heeg & Ron Peters & Marc Botteman & Ben Hout, 2007. "Long-Term Clopidogrel Therapy in Patients Receiving Percutaneous Coronary Intervention," PharmacoEconomics, Springer, vol. 25(9), pages 769-782, September.
    • Handle: RePEc:spr:pharme:v:25:y:2007:i:9:p:769-782
    DOI: 10.2165/00019053-200725090-00005
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    References listed on IDEAS

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    1. Joel Tsevat & Lee Goldman & Jane R. Soukup & Gervasio A. Lamas & Kathleen F. Connors & Carole C. Chapin & Thomas H. Lee, 1993. "Stability of Time-tradeoff Utilities in Survivors of Myocardial Infarction," Medical Decision Making, , vol. 13(2), pages 161-165, June.
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    3. Anna Ringborg & Peter Lindgren & Bengt Jönsson, 2005. "The cost-effectiveness of dual oral antiplatelet therapy following percutaneous coronary intervention," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(4), pages 354-362, December.
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    1. Alexander V van Schoonhoven & Judith J Gout-Zwart & Marijke J S de Vries & Antoinette D I van Asselt & Evgeni Dvortsin & Pepijn Vemer & Job F M van Boven & Maarten J Postma, 2019. "Costs of clinical events in type 2 diabetes mellitus patients in the Netherlands: A systematic review," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-22, September.
    2. J. Logman & Bart Heeg & Johan Herlitz & Ben Hout, 2010. "Costs and consequences of clopidogrel versus aspirin for secondary prevention of ischaemic events in (high-risk) atherosclerotic patients in Sweden," Applied Health Economics and Health Policy, Springer, vol. 8(4), pages 251-265, July.
    3. Elek, Péter & Harsányi, András & Zelei, Tamás & Csetneki, Kata & Kaló, Zoltán, 2017. "Policy objective of generic medicines from the investment perspective: The case of clopidogrel," Health Policy, Elsevier, vol. 121(5), pages 558-565.

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