Cost-effectiveness of clopidogrel in patients with acute coronary syndrome in Switzerland

Summary Background: The results of the Clopidogrel in Unstable Angina to prevent Recurrent Events (CURE)-trial have demonstrated that the use of clopidogrel in addition to standard treatment with acetylsalicyl-acid (ASA) alone has led to a reduction in the incidence of events defined as cardiovascular death, myocardial infarction and stroke in patients with unstable angina. The aim of this study was to examine the cost-effectiveness of this treatment strategy. Methods: Resource use was identified from the case report forms (CRFs) of all patients in the CURE study and grouped into initial hospitalisation, re-hospitalisations, study drug, and concomitant medications. The initial and re-hospitalisations were assigned to a diagnosis related group (DRG) in a blinded automated fashion. Clopidogrel uptake was assessed based on the number of days on treatment. To assess concomitant medication use recommended doses and durations were applied, since on the CRFs only yes/no answers were recorded. Hospitalisations were assigned a DRG specific flat rate based on the costweights of the Swiss All Patient Diagnosis Related Groups (APDRG). The study drug and concomitant medication were valued at retail prices. The number of life years saved was estimated using the DEALE-approximation. Results: Patients in the clopidogrel + ASA arm have on average slightly higher costs than patients treated with ASA alone, CHF 14 839 as compared to CHF 14 380. This is due to the acquisition cost of clopidogrel (CHF 775) which is partly offset by savings during the initial and subsequent hospitalisations. These cost offsets were CHF 327, the other costs were quite similar in both groups. Treatment with clopidogrel led to 0.12 life years saved. The incremental cost-effectiveness, ie the incremental cost per life year saved, of clopidogrel and ASA over ASA alone was CHF 3810. This is comparable to other cost-effective therapies in cardiovascular disease.