The cost-effectiveness of the use of clopidogrel in acute coronary syndromes in five countries based upon the CURE study

BACKGROUND: The CURE study demonstrated that clopidogrel prevents a range of ischaemic cardiovascular events in patients with Acute Coronary Syndromes (unstable angina or non-ST-segment elevation MI). DESIGN: We undertook an economic analysis of the use of clopidogrel in the UK, USA, Sweden, France and Canada based on the CURE study. METHODS: The costs of hospitalization, study drug and other medications were calculated, based on resource utilization for all patients in CURE. Unit costs were obtained for all resource items for each country, and are reported in local currencies in 2001 prices. RESULTS: While hospitalization costs were lower in the clopidogrel group, when the acquisition cost of clopidogrel for 9 months is included, the average cost per patient is higher in the clopidogrel group than the placebo group in all countries [difference in costs (with 95% CI) 208 pounds sterling (119, 297), 451 US dollars (58, 845), SKr 2571 (728, 4412), 325 euros (85, 565), 161 Canadian dollars (-185, 506)]. The absolute reduction in the number of total primary events was 2.0%, resulting in an incremental cost-effectiveness ratio (ICER) of 10,366 pounds sterling in the UK, 22,484 US dollars in the USA, SKr 127,951 in Sweden, 16,186 euros in France, and 7973 Canadian dollars in Canada per primary event avoided with clopidogrel. CONCLUSIONS: Clopidogrel in CURE reduced hospitalization costs but the acquisition cost of clopidogrel creates an overall increase in direct health care costs over 9 months. Nevertheless, the cost-effectiveness is in a range comparable to other therapies currently utilized for acute coronary syndromes.