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Cost-Effectiveness of Aspirin and Clopidogrel
What do we do when the most effective regimen is not necessarily the most cost-effective?
Antiplatelet agents have emerged as important therapy for secondary prevention of coronary heart disease (CHD). Evidence shows that, compared with aspirin, clopidogrel can reduce the combined risk for MI, stroke, or death. Moreover, in patients with an acute coronary syndrome, adding clopidogrel to aspirin therapy can further reduce risk for future adverse events. Is the additional cost of clopidogrel worth its extra benefit? These investigators used computer simulation to estimate the cost-effectiveness of several antiplatelet treatment strategies in U.S. patients with CHD (age range, 35 to 84) from 2003 to 2027.
Compared with current practice patterns, extending aspirin therapy to all eligible CHD patients (not yet a reality) would cost $11,000 per quality-adjusted life-year (QALY) gained. A strategy of aspirin for all eligible patients and clopidogrel for those with aspirin intolerance had a cost-effectiveness ratio of $31,000 per QALY gained over aspirin alone. Clopidogrel for all patients had a cost-effectiveness ratio of $250,000 per QALY gained over the $31,000 strategy. Finally, for a strategy of clopidogrel for all patients plus aspirin for eligible patients, the ratio was $130,000 per QALY gained over the $31,000 strategy.
Comment: This analysis shows the potential costs of various antiplatelet-therapy strategies. Patients may wish to have the most effective regimen, but payors may consider the cost-benefit ratio too high. This type of analysis should prompt discussions about resource allocations in the healthcare system. Are we ready to debate how much we are willing to pay to improve outcomes?
— Harlan M. Krumholz, MD, SM
Published in Journal Watch Cardiology August 16, 2002
Citation(s):
Gaspoz J-M et al. Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. N Engl J Med 2002 Jun 6; 346:1800-6.
- Medline abstract (Free)
Wood AJJ. When increased therapeutic benefit comes at increased cost. N Engl J Med 2002 Jun 6; 346:1819-21.
- Medline abstract (Free)
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