Modelling the long term cost effectiveness of clopidogrel for the secondary prevention of occlusive vascular events in the UK

J Karnon, A Brennan, A Pandor, G Fowkes, Amanda Jane Lee, D Gray, C Coshall, C Nicholls, R Akehurst

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To assess the long term cost effectiveness of clopidogrel monotherapy compared with acetylsalicylic acid (aspirin; ASA) monotherapy in patients at risk of secondary occlusive vascular events (OVEs) in the UK.
Design: Cost utility analysis based on clinical data from CAPRIE (a multicentre randomised controlled trial, involving 19 185 patients); long-term effects were extrapolated beyond the trial period using a Markov model populated with data from UK observational studies. Health economic evaluation carried out from the perspective of the UK National Health Service.
Participants: A representative cohort of 1000 UK patients aged 60 years (approximate mean age of the CAPRIE population), with the qualifying diagnoses of myocardial infarction, ischaemic stroke and peripheral arterial disease, who are at risk of secondary OVEs (non-fatal myocardial infarction, non-fatal stroke or vascular death).
Interventions: Patients were assumed to receive treatment with either clopidogrel (75 mg/day) for 2 years followed by ASA (325 mg/day, average) for their remaining lifetime, or ASA alone (325 mg/day, average) 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 clopidogrel versus ASA in this population is estimated at pound18 888 per life year gained and pound21 489 per QALY gained. Multiple deterministic and probabilistic sensitivity analyses suggest the model is robust to variations in a wide range of input parameters.
Conclusion: Two years of treatment with clopidogrel can be considered a cost effective intervention in patients at risk of secondary OVEs in the UK.

Original languageEnglish
Pages (from-to)101-112
Number of pages12
JournalCurrent Medical Research and Opinion
Volume21
Issue number1
DOIs
Publication statusPublished - Jan 2005

Keywords

  • aspirin
  • clopidogrel
  • cost effectiveness
  • Markov model
  • QALY
  • secondary prevention
  • occlusive vascular event (OVE)
  • UK
  • coronary heart disease
  • major cardiovascular events
  • myocardial infarction
  • antiplatelet therapy
  • randomized trials
  • ischemic events
  • stroke
  • risk
  • dipyridamole

Cite this

Modelling the long term cost effectiveness of clopidogrel for the secondary prevention of occlusive vascular events in the UK. / Karnon, J ; Brennan, A ; Pandor, A ; Fowkes, G ; Lee, Amanda Jane; Gray, D ; Coshall, C ; Nicholls, C ; Akehurst, R .

In: Current Medical Research and Opinion, Vol. 21, No. 1, 01.2005, p. 101-112.

Research output: Contribution to journalArticle

Karnon, J ; Brennan, A ; Pandor, A ; Fowkes, G ; Lee, Amanda Jane ; Gray, D ; Coshall, C ; Nicholls, C ; Akehurst, R . / Modelling the long term cost effectiveness of clopidogrel for the secondary prevention of occlusive vascular events in the UK. In: Current Medical Research and Opinion. 2005 ; Vol. 21, No. 1. pp. 101-112.
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abstract = "Objective: To assess the long term cost effectiveness of clopidogrel monotherapy compared with acetylsalicylic acid (aspirin; ASA) monotherapy in patients at risk of secondary occlusive vascular events (OVEs) in the UK. Design: Cost utility analysis based on clinical data from CAPRIE (a multicentre randomised controlled trial, involving 19 185 patients); long-term effects were extrapolated beyond the trial period using a Markov model populated with data from UK observational studies. Health economic evaluation carried out from the perspective of the UK National Health Service. Participants: A representative cohort of 1000 UK patients aged 60 years (approximate mean age of the CAPRIE population), with the qualifying diagnoses of myocardial infarction, ischaemic stroke and peripheral arterial disease, who are at risk of secondary OVEs (non-fatal myocardial infarction, non-fatal stroke or vascular death). Interventions: Patients were assumed to receive treatment with either clopidogrel (75 mg/day) for 2 years followed by ASA (325 mg/day, average) for their remaining lifetime, or ASA alone (325 mg/day, average) 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 clopidogrel versus ASA in this population is estimated at pound18 888 per life year gained and pound21 489 per QALY gained. Multiple deterministic and probabilistic sensitivity analyses suggest the model is robust to variations in a wide range of input parameters. Conclusion: Two years of treatment with clopidogrel can be considered a cost effective intervention in patients at risk of secondary OVEs in the UK.",
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AB - Objective: To assess the long term cost effectiveness of clopidogrel monotherapy compared with acetylsalicylic acid (aspirin; ASA) monotherapy in patients at risk of secondary occlusive vascular events (OVEs) in the UK. Design: Cost utility analysis based on clinical data from CAPRIE (a multicentre randomised controlled trial, involving 19 185 patients); long-term effects were extrapolated beyond the trial period using a Markov model populated with data from UK observational studies. Health economic evaluation carried out from the perspective of the UK National Health Service. Participants: A representative cohort of 1000 UK patients aged 60 years (approximate mean age of the CAPRIE population), with the qualifying diagnoses of myocardial infarction, ischaemic stroke and peripheral arterial disease, who are at risk of secondary OVEs (non-fatal myocardial infarction, non-fatal stroke or vascular death). Interventions: Patients were assumed to receive treatment with either clopidogrel (75 mg/day) for 2 years followed by ASA (325 mg/day, average) for their remaining lifetime, or ASA alone (325 mg/day, average) 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 clopidogrel versus ASA in this population is estimated at pound18 888 per life year gained and pound21 489 per QALY gained. Multiple deterministic and probabilistic sensitivity analyses suggest the model is robust to variations in a wide range of input parameters. Conclusion: Two years of treatment with clopidogrel can be considered a cost effective intervention in patients at risk of secondary OVEs in the UK.

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KW - major cardiovascular events

KW - myocardial infarction

KW - antiplatelet therapy

KW - randomized trials

KW - ischemic events

KW - stroke

KW - risk

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