February 15, 2005Annals of Internal Medicine
A Cost-Effectiveness Analysis of Combination Antiplatelet Therapy for High-Risk Acute Coronary Syndromes: Clopidogrel plus Aspirin versus Aspirin Alone
Why the study?
Does combination therapy with clopidogrel plus aspirin improve cost-effectiveness compared with aspirin alone in patients with unstable angina and electrocardiographic changes or non-Q-wave myocardial infarction?
Population
Patients with unstable angina and electrocardiographic changes or non-Q-wave myocardial infarction
Comparison
Combination therapy with clopidogrel, 75 mg/d… vs Lifelong aspirin therapy, 325 mg/d
Design
Other
Follow-up
Lifetime
Authors
Discussion
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Implication
Supports cost-effectiveness of clopidogrel plus aspirin in high-risk ACS at conventional thresholds; leaves open generalizability to contemporary regimens and populations.
Structured PICO
Does combination therapy with clopidogrel plus aspirin improve cost-effectiveness compared with aspirin alone in patients with unstable angina and electrocardiographic changes or non-Q-wave myocardial infarction?
P
Population
Patients with unstable angina and electrocardiographic changes or non-Q-wave myocardial infarction
I
Intervention
Combination therapy with clopidogrel, 75 mg/d, plus aspirin, 325 mg/d, for 1 year, followed by aspirin monotherapy
C
Comparator
Lifelong aspirin therapy, 325 mg/d
O
Outcome
Lifetime costs, life expectancy in quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio
In patients with high-risk acute coronary syndromes, 1 year of clopidogrel plus aspirin is cost-effective compared to aspirin alone, with an incremental cost-effectiveness ratio of $15,400 per QALY.
Limitations
- May not apply to patients with severe heart failure
- May not apply to those undergoing long-term anticoagulant therapy
- May not apply to those recently managed with revascularization
- May not apply to those undergoing short-term treatment with glycoprotein IIb/IIIa inhibitors
Cite This Study
Schleinitz et al. (2005) studied this question.