Cost-Effectiveness of Clopidogrel plus Aspirin versus Aspirin Alone for Secondary Prevention of Cardiovascular Events: Results from the CHARISMA Trial
| Autor: | Sylvie Gabriel, J. Jaime Caro, Chunxue Shi, Elizabeth Schneider Dunn, David J. Cohen, Eric J. Topol, Elizabeth M. Mahoney, Deepak L. Bhatt, Jersey Chen, Joseph Jackson |
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| Rok vydání: | 2009 |
| Předmět: |
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medicine.medical_specialty Ticlopidine Databases Factual aspirin Cost effectiveness Cost-Benefit Analysis Population Life Expectancy cardiovascular disease Internal medicine medicine Humans Multicenter Studies as Topic Myocardial infarction education Stroke health care economics and organizations Aged Randomized Controlled Trials as Topic clopidogrel Aspirin education.field_of_study business.industry Health Policy cost-effectiveness analysis Public Health Environmental and Occupational Health Health Care Costs Cost-effectiveness analysis Middle Aged medicine.disease Clopidogrel Survival Analysis Saskatchewan United States Hospitalization Cardiovascular Diseases Cohort Cardiology Drug Therapy Combination Female business Platelet Aggregation Inhibitors secondary prevention medicine.drug |
| Zdroj: | Value in Health. 12(6):872-879 |
| ISSN: | 1098-3015 |
| DOI: | 10.1111/j.1524-4733.2009.00529.x |
| Popis: | ObjectiveTo determine the incremental cost-effectiveness of clopidogrel plus aspirin (C + A) compared with aspirin (A) alone during the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial from a US payer perspective.BackgroundAlthough the CHARISMA trial did not find a benefit of adding clopidogrel to aspirin in its overall study cohort, a benefit was suggested in a prespecified subgroup of patients with established cardiovascular (CV) disease. The cost-effectiveness of dual antiplatelet therapy in this population is unknown.MethodsMedical resource utilization was assessed prospectively, and costs for hospitalizations, physician services, outpatient care, and medications were assigned using 2007 US dollars. Life expectancy was estimated contingent on fatal and nonfatal CV events using statistical models of long-term survival from the Saskatchewan Health database.ResultsC + A was associated with a 12.5% relative reduction in CV death, myocardial infarction, or stroke compared with A alone (6.9% vs. 7.9%, P = 0.048) over a median 28 months of follow-up. Severe or moderate bleeding events were higher in patients receiving C + A versus A alone (3.6% vs. 2.5%, P < 0.001). Mean cost/patient was $2607 higher for C + A, while projected life expectancy increased by an average of 0.072 years due to fewer in-trial events. The resulting incremental cost-effectiveness ratio (ICER) for C + A was $36,343/year of life gained. Findings were insensitive to discount rate, life expectancy projections, post-event costs, and indirect costs from lost productivity; the ICER was most sensitive to the cost of clopidogrel. Bootstrap analysis demonstrated that the ICER for C + A remained |
| Databáze: | OpenAIRE |
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