IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v28y2008i6p803-809.html
   My bibliography  Save this article

Cost-Effectiveness of Clopidogrel: Seeing through the Smoke

Author

Listed:
  • Lee Goldman

    (Columbia University College of Physicians and Surgeons, New York)

  • Jean-Michel Gaspoz

    (Department of Community Medicine and Primary Care, Geneva University Hospitals and University of Geneva, Geneva, Switzerland, jean-michel.gaspoz@hcuge.ch)

Abstract

Background . A recent article in this journal raised specific questions about the authors' methods for modeling the cost-effectiveness of clopidogrel for secondary prevention of coronary heart disease. The key issues raised were inclusion of incident cases, time horizon, and use of an inclusive model structure. Methods . The authors reviewed various recommendations and practices for cost-effectiveness analysis. They also performed a PubMed search for clopidogrel and cost-effectiveness from 2004 to early 2008 to obtain original analyses published in English to look for possible associations of assumptions and conclusions with reported pharmaceutical support. Results . Inclusion of incident cases and truncation at a sensible follow-up time more appropriately reflect the burden to be assumed by third-party payers. Extending the time horizon too far runs the risk of decreasing any relation with future reality. Parsimony cannot justify simplifications that omit relevant issues such as noncoronary costs, which worsen the calculated cost-effectiveness ratio of clopidogrel by 5% to 27%. The choice of the population to be analyzed has a major effect on cost-effectiveness: pharmaceutically sponsored studies published between 2004 and early 2008 focused on high-risk patients and have routinely shown more favorable cost-effectiveness ratios for clopidogrel than studies without pharmaceutical support. Conclusion . Any entity hoping to make the cost-effectiveness ratio of clopidogrel look more favorable would prefer the isolated, cohort approach and limit the analysis to high-risk patients most likely to benefit from it. This approach ignores the reality of medical policies and does not address the most relevant questions regarding the optimum use of clopidogrel.

Suggested Citation

  • Lee Goldman & Jean-Michel Gaspoz, 2008. "Cost-Effectiveness of Clopidogrel: Seeing through the Smoke," Medical Decision Making, , vol. 28(6), pages 803-809, November.
    • Handle: RePEc:sae:medema:v:28:y:2008:i:6:p:803-809
    DOI: 10.1177/0272989X08318467
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X08318467
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0272989X08318467?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Jonathan Karnon & Alan Brennan & Ron Akehurst, 2007. "A Critique and Impact Analysis of Decision Modeling Assumptions," Medical Decision Making, , vol. 27(4), pages 491-499, July.
    2. Paul F. M. Krabbe & Eddy M. M. Adang & Peep F. M. Stalmeier & Bruce R. Schackman & John Brazier & Milton C. Weinstein, 2003. "Letter to the Editor," Medical Decision Making, , vol. 23(6), pages 542-543, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. World Bank, 2007. "Making the Most of Scarcity : Accountability for Better Water Management Results in the Middle East and North Africa," World Bank Publications - Books, The World Bank Group, number 6845.
    2. Jean Hillier, 2009. "Assemblages of Justice: The ‘Ghost Ships’ of Graythorp," International Journal of Urban and Regional Research, Wiley Blackwell, vol. 33(3), pages 640-661, September.
    3. Krausmann, Fridolin & Erb, Karl-Heinz & Gingrich, Simone & Lauk, Christian & Haberl, Helmut, 2008. "Global patterns of socioeconomic biomass flows in the year 2000: A comprehensive assessment of supply, consumption and constraints," Ecological Economics, Elsevier, vol. 65(3), pages 471-487, April.
    4. Davern, Michael J. & Wilkin, Carla L., 2010. "Towards an integrated view of IT value measurement," International Journal of Accounting Information Systems, Elsevier, vol. 11(1), pages 42-60.
    5. Planko & Jacqueline Cramer & Maryse Chappin & Marko Hekkert, 2014. "Strategic collective system building by firms who launch sustainability innovations," Innovation Studies Utrecht (ISU) working paper series 14-04, Utrecht University, Department of Innovation Studies, revised Sep 2014.
    6. Michael Webber, 2012. "Making Capitalism in Rural China," Books, Edward Elgar Publishing, number 14446.
    7. Karen M. Kuntz & Elisabeth Fenwick & Andrew Briggs, 2010. "Appropriate Cohorts for Cost-Effectiveness Analysis: To Mix or Not to Mix?," Medical Decision Making, , vol. 30(4), pages 424-425, July.
    8. James Ted McDonald, 2005. "The Health Behaviors of Immigrants and Native-born People in Canada," Social and Economic Dimensions of an Aging Population Research Papers 144, McMaster University.
    9. Saadet Kirbas-Kasman & Adnan Kasman, 2003. "Volatility of ISE and Business Cycle," Central Bank Review, Research and Monetary Policy Department, Central Bank of the Republic of Turkey, vol. 3(1), pages 67-84.
    10. Katharine E. Schmitz & Melbourne F. Hovell & Charlene A. Wong & Norma J. Kelley & Donata Nilsen & Elaine J. Blumberg & Linda L. Hill & Carol L. Sipan & Bo Kolody & Dale A. Chatfield, 2010. "The Reliability and Practicality of the Arkansas Method Assay of Isoniazid Adherence," Clinical Nursing Research, , vol. 19(2), pages 131-143, May.
    11. Vivian Ho, 2006. "Does certificate of need affect cardiac outcomes and costs?," International Journal of Health Economics and Management, Springer, vol. 6(4), pages 300-324, December.
    12. Jonathan Karnon & Alan Brennan & Ron Akehurst, 2010. "Decision Modeling to Inform Decision Making: Seeing the Wood for the Trees," Medical Decision Making, , vol. 30(3), pages 20-22, May.
    13. Gerardo P. Sicat, 2004. "Reforming the Philippine Labor Market," UP School of Economics Discussion Papers 200404, University of the Philippines School of Economics.
    14. Detlef Seese & Christof Weinhardt & Frank Schlottmann (ed.), 2008. "Handbook on Information Technology in Finance," International Handbooks on Information Systems, Springer, number 978-3-540-49487-4, November.
    15. Hamid Beladi & Nicholas S. P. Tay & Reza Oladi, 2011. "On Competition for Listings," Working Papers 0003, College of Business, University of Texas at San Antonio.
    16. Masoumeh Shohani & Firoz Balavandi & Reza Valizadeh & Hamed Tavan, 2017. "Threats and Opportunities of the Health Reform Plan from the Nurses’ Perspective in Ilam," Global Journal of Health Science, Canadian Center of Science and Education, vol. 9(5), pages 1-85, May.
    17. Christoph Augner & Gerhard Hacker, 2012. "Associations between problematic mobile phone use and psychological parameters in young adults," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 57(2), pages 437-441, April.
    18. Christopher McCabe, 2007. "Guidance on Good Practice in Cost-Effectiveness Modeling: Is More Needed?," Medical Decision Making, , vol. 27(4), pages 350-351, July.
    19. Wulfhorst, J. D. & Rimbey, Neil R. & Darden, Tim D., 2003. "Social And Community Impacts Of Public Land Grazing Policy Alternatives In The Bruneau Resource Area Of Owyhee County, Idaho," A.E. Extension Series 304818, University of Idaho, Department of Agricultural Economics and Rural Sociology.
    20. Limnios, N., 2006. "Estimation of the stationary distribution of semi-Markov processes with Borel state space," Statistics & Probability Letters, Elsevier, vol. 76(14), pages 1536-1542, August.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:28:y:2008:i:6:p:803-809. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.