Clopidogrel is more effective than aspirin in preventing recurrent strokes or heart attacks, but concerns about its high cost have limited use of this antiplatelet drug. According to a new study, clopidogrel is cost effective for patients with either peripheral arterial disease (PAD, slowed blood flow in the arteries, usually the legs, due to narrowing from fatty deposits) or a recent stroke, even at a daily cost that is almost twice the average wholesale cost. However, clopidogrel is more expensive and less effective than aspirin for patients who have had a heart attack.
Mark D. Schleinitz, M.S., M.D., of Brown University, and his colleagues found that clopidogrel increased the life expectancy of PAD patients by almost 7 months (0.55 quality-adjusted life years, QALYs) compared with aspirin, at
an incremental cost-effectiveness ratio of $25,100 per QALY. Clopidogrel increased life expectancy among stroke patients by just 2 months (0.17 QALYs) over aspirin, at a cost of $31,200 per QALY. However for patients treated after a heart attack, life expectancy with clopidogrel was about 3 months (0.26 QALYs) shorter than with aspirin.
These findings are based on a model that based analyses on the lifetime treatment of a 63-year-old patient facing event probabilities (heart attack, stroke, amputation, vascular death, gastrointestinal bleeding, or intracranial hemorrhage) derived from the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial. The model assessed the probability of events expected in a hypothetical group of 250,000 patients. Avoidance of hemorrhage contributed to the cost-effectiveness of clopidogrel in all patient groups. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00028).
See "Clopidogrel versus aspirin for secondary prophylaxis of vascular events: A cost-effectiveness analysis," by Dr. Schleinitz, J. Peter Weiss, M.S., M.D., and Douglas K. Owens, M.S., M.D., in the June 15, 2004, American Journal of Medicine 116, pp. 797-806.
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