PharmacoEconomics

, Volume 25, Issue 9, pp 769–782

Long-Term Clopidogrel Therapy in Patients Receiving Percutaneous Coronary Intervention

Authors

    • Pharmerit International
  • Ron J. G. Peters
    • Department of CardiologyAcademic Medical Centre
  • Marc Botteman
    • Pharmerit International
  • Ben A. van Hout
    • Pharmerit International
Original Research Article

DOI: 10.2165/00019053-200725090-00005

Cite this article as:
Heeg, B.M.S., Peters, R.J.G., Botteman, M. et al. Pharmacoeconomics (2007) 25: 769. doi:10.2165/00019053-200725090-00005

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.

Supplementary material

40273_2012_25090769_MOESM1_ESM.pdf (146 kb)
Supplementary material, approximately 149 KB.

Copyright information

© Adis Data Information BV 2007