A cost-utility analysis of clopidogrel in patients with ST elevation acute coronary syndromes in the UK

ObjectiveTo assess the long-term cost effectiveness of treatment for 1 month, and for 1 year with clopidogrel in addition to standard therapy (including aspirin) compared with standard therapy alone, in patients diagnosed with ST elevation acute myocardial infarction (STEMI) in the UK.DesignCost utility analysis using a cohort Markov model, incorporating clinical data from two pivotal clinical trials (the COMMIT/CCS-2 and CLARITY-TIMI 28 trials) and data from UK and non-UK observational studies.SettingHealth economic evaluation carried out from the perspective of the UK NHS.PatientsA representative cohort of 1000 UK patients aged 60 years, diagnosed with STEMI.Interventions75 mg/day clopidogrel, with and without a 300 mg loading dose, in addition to standard therapy (including aspirin, 75–325 mg/day) for 1 month, and for 1 year, followed by standard therapy alone for their remaining lifetime, or standard therapy alone (including aspirin, 75–325 mg/day) for their remaining lifetime.Main outcome measuresIncremental cost per quality-adjusted life-year (QALY) gained (ICER).ResultsFor the 1-month treatment option both the COMMIT/CCS-2 and CLARITY-TIMI 28 trials have ICERs below £2500. For the 1-year treatment option both trials have ICERs below £4000. Extensive univariate and probabilistic sensitivity analyses showed these results to be robust.ConclusionsIn combination with previous economic analyses of clopidogrel in NSTEMI patients, this paper demonstrates that clopidogrel appears to offer a cost-effective treatment option for all ACS patients.