Cost-effectiveness of clopidogrel in acute coronary syndromes in Sweden: a long-term model based on the CURE trial.

Abstract

The purpose of this study was to evaluate the long-term cost-effectiveness of clopidogrel on top of standard therapy (including ASA) in patients with acute coronary syndromes without ST-segment elevation in Sweden. Incremental cost-effectiveness ratios (ICER) were assessed using a Markov model with transition probabilities estimated from the Swedish hospital discharge and cause of death registers. Patients were assumed to be treated for 1 year, with treatment effects (RR = 0.8) and costs taken from the Clopidogrel in Unstable Angina to prevent Recurrent ischaemic Events Trial. Two scenarios were analysed: with patients similar to those in the trial and with patients similar to those from the register. In the first scenario, the predicted net direct cost was 160 euro and the net total cost -54 euro, which with an incremental survival of 0.12 years give the ICER of 1365 euro per life-year gained from the health care payer perspective (including direct costs) and cost savings from the societal perspective (also including indirect costs). The net costs in the second scenario were 149 euro, giving an ICER of 1009 euro for both perspectives. Adding clopidogrel to standard therapy including ASA is cost-effective in the studied setting and compares favourably with other cardiovascular treatment and prevention strategies.