Abstract 3859: Cost-Effectiveness of Clopidogrel in Patients With ST-Segment Elevation Myocardial Infarction
Background: The COMMIT trial demonstrated that allocation to clopidogrel produced a significant 9% proportional reduction in death, reinfarction or stroke (9.2% clopidogrel vs 10.1% placebo, 95% CI 0.86 to 0.97). We consider the cost-effectiveness of clopidogrel in COMMIT.
Methods: 45852 patients were randomized to clopidogrel 75 mg/day (n = 22961) or matching placebo (n = 22891) in addition to aspirin 162 mg daily between 08/99 and 05/05. Treatment was to continue until discharge or up to 4 weeks. The number of initial hospitalizations for death, non-fatal MI with or without major complications and PCI within 28 days was estimated based on the COMMIT clinical paper. The CURE papers were used to estimate the number of subsequent hospitalizations for death, non-fatal MI, stroke, bleeding, angina and revascularization between 29 days and 1 year. Hospitalizations were assigned a diagnosis-related group (DRG). Costs for each DRG (year 2003) were estimated from Medicare reimbursement rates. Physician costs were estimated as a percentage of hospital costs by DRG. Clopidogrel was assumed to be given as 1 year and priced at $3.80/day. Life expectancy gains as a result of the prevention of the major clinical events of death, MI, and stroke were estimated using Framingham data. Cost-effectiveness analysis was performed as incremental costs per life year gained (LYG).
Results: Within 28 days, adding clopidogrel to aspirin is likely a dominant strategy, lowering event rate without an increase in costs. For the life time period, the incremental cost-effectiveness ratio of clopidogrel is $4896/LYG. Sensitivity analyses, which were performed assuming additional increase or decrease of 10%, 20%, 30%, and 40% based on the estimated reduction rates of death, MI and stroke for clopidogrel, showed that the ICERs range from $4070/LYG to $6034/LYG.
Conclusions: Addition of clopidogrel to aspirin, given up to 1 year, in the setting of ST-segment elevation MI is highly a cost-effective strategy.