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Long-Term Clopidogrel Therapy in Patients Receiving Percutaneous Coronary Intervention

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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.

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Acknowledgements

The authors would like to acknowledge Frank de Charro and Maarten Treur for their help during the preparation of this paper. The article was supported by a grant from Sanofi-Aventis, The Netherlands. The authors maintained control of all analyses and the content of this manuscript.

Bart Heeg is employed by, and Marc Botteman and Ben van Hout are partners of, Pharmerit. Pharmerit has contracts with Sanofi-Aventis. Ron Peters and Ben van Hout have received consultancy fees and honoraria from Sanofi-Aventis.

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Authors and Affiliations

  1. Pharmerit International, Marten Meesweg 143, Rotterdam, 3069 DN, The Netherlands

    Bart M. S. Heeg & Ben A. van Hout

  2. Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands

    Ron J. G. Peters

  3. Pharmerit International, Bethesda, USA

    Marc Botteman

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  1. Bart M. S. Heeg
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  2. Ron J. G. Peters
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Correspondence to Bart M. S. Heeg.

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Heeg, B.M.S., Peters, R.J.G., Botteman, M. et al. Long-Term Clopidogrel Therapy in Patients Receiving Percutaneous Coronary Intervention. Pharmacoeconomics 25, 769–782 (2007). https://doi.org/10.2165/00019053-200725090-00005

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