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

Objective To assess the long-term cost effectiveness of 1 yearʹs treatment with clopidogrel on top of standard therapy (including aspirin; ASA) compared with standard therapy alone, in patients diagnosed with non-ST-segment-elevation acute coronary syndromes (ACS) in the UK. Design Cost utility analysis using a Markov model, incorporating clinical data from CURE (a multicentre randomised controlled trial, involving 12,562 patients) and data from UK observational studies. Setting Health economic evaluation carried out from the perspective of the UK NHS. Patients A representative cohort of 1000 UK patients aged 66 years, diagnosed with non-ST-segment-elevation ACS. Interventions Either a combination of 75 mg/day clopidogrel (300 mg loading dose, within 24 h prior to hospital admission) and standard therapy (including ASA, 75–325 mg/day) for 1 year followed by standard therapy alone for their remaining lifetime, or standard therapy alone (including ASA, 75–325 mg/day) for life. Main outcome measures Incremental cost per life-year gained and incremental cost per quality-adjusted life-year (QALY) gained. Results In the base case, the incremental cost effectiveness of the clopidogrel combination vs standard therapy alone is estimated as £6991 per life-year gained and £7365 per QALY gained. The probability that clopidogrel remains cost effective within the generally accepted £30,000 per QALY threshold is more than 80%. The confidence interval around the relative risk for vascular death was identified as the main parameter affecting the estimated cost effectiveness. Conclusions One yearʹs treatment with clopidogrel is a cost effective intervention compared with standard therapy that should be considered as a routine treatment for patients with non-ST-segment-elevation ACS.