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A Cost-Effectiveness Analysis of Clopidogrel for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome in China

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Abstract

Introduction

There are a number of economic evaluation studies of clopidogrel for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost effectiveness for up to 1-year treatment with clopidogrel plus acetylsalicylic acid (ASA) versus ASA alone for NSTEACS from the public payer perspective in China.

Methods

This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon. Based on the primary event rates, adherence rate, and mortality derived from the CURE trial, hazard functions obtained from published literature were used to extrapolate the overall survival to lifetime horizon. Resource utilization, hospitalization, medication costs, and utility values were estimated from official reports, published literature, and analysis of the patient-level insurance data in China. To assess the impact of parameters’ uncertainty on cost-effectiveness results, one-way sensitivity analyses were undertaken for key parameters, and probabilistic sensitivity analysis (PSA) was conducted using the Monte Carlo simulation.

Results

The therapy of clopidogrel plus ASA is a cost-effective option in comparison with ASA alone for the treatment of NSTEACS in China, leading to 0.0548 life years (LYs) and 0.0518 QALYs gained per patient. From the public payer perspective in China, clopidogrel plus ASA is associated with an incremental cost of 43,340 China Yuan (CNY) per QALY gained and 41,030 CNY per LY gained (discounting at 3.5% per year). PSA results demonstrated that 88% of simulations were lower than the cost-effectiveness threshold of 150,721 CYN per QALY gained. Based on the one-way sensitivity analysis, results are most sensitive to price of clopidogrel, but remain well below this threshold.

Conclusion

This analysis suggests that treatment with clopidogrel plus ASA for up to 1 year for patients with NSTEACS is cost effective in the local context of China from a public payers’ perspective.

Funding

Sanofi China.

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Acknowledgments

Sponsorship and article processing charges for this study were funded by Sanofi China. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given the final approval for the version to be published.

Disclosures

Seng Chuen Tan and Can Chen are the current employees of IMS Health Asia Pacific, a consultancy that has received funds from Sanofi China. Ming Cui, Chen Chen Tu, Er Zhen Chen, and Xiao Li Wang declare that they have no competing interests.

Compliance with Ethics Guidelines

The analysis in this article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Peking University Third Hospital, Beijing, China

    Ming Cui

  2. Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Chen Chen Tu

  3. Shanghai Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Er Zhen Chen

  4. China-Japan Friendship Hospital, Beijing, China

    Xiao Li Wang

  5. IMS Health Asia, Singapore, Singapore

    Seng Chuen Tan

  6. IMS Health Asia, Shanghai, China

    Can Chen

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  1. Ming Cui
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  2. Chen Chen Tu
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  3. Er Zhen Chen
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Correspondence to Can Chen.

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Cui, M., Tu, C.C., Chen, E.Z. et al. A Cost-Effectiveness Analysis of Clopidogrel for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome in China. Adv Ther 33, 1600–1611 (2016). https://doi.org/10.1007/s12325-016-0375-9

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  • DOI: https://doi.org/10.1007/s12325-016-0375-9

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