IDEAS home Printed from https://ideas.repec.org/a/spr/pharme/v25y2007i9p769-782.html
   My bibliography  Save this article

Long-Term Clopidogrel Therapy in Patients Receiving Percutaneous Coronary Intervention

Author

Listed:
  • Bart Heeg
  • Ron Peters
  • Marc Botteman
  • Ben Hout

Abstract

Background: The PCI-CURE (Percutaneous Coronary Intervention-Clopidogrel in Unstable Angina to Prevent Recurrent Events) and CREDO (Clopidogrel for the Reduction of Events During Observation) studies have demonstrated that, in addition to aspirin, pre-treatment with clopidogrel followed by long-term (i.e. 9—12 months) therapy significantly reduces the risk of atherothrombotic events in patients undergoing percutaneous coronary intervention (PCI). Objective: To examine the economic implications, from the Dutch healthcare perspective, of the use of clopidogrel in patients undergoing PCI (elective procedures or in patients with acute coronary syndrome), comparing pre-treatment followed by long-term therapy with only 4 weeks of treatment. Methods: A lifetime Markov model was used to combine data from the PCI-CURE and CREDO trials with data from the literature concerning epidemiology, costs and quality of life. The model was run separately for each trial. Only direct healthcare costs (€, year 2004 values) were considered. Costs and outcomes were discounted at 4% per anum. For each trial, the cost effectiveness is expressed as costs per life-year and QALY gained. Uncertainties are addressed by uni- and probabilistic multivariate sensitivity analysis. Results: When starting with the data from the PCI-CURE trial, pre-treatment plus 9-month clopidogrel therapy was predicted to save €1119 and gain 0.03 life-years and 0.07 QALYs per patient compared with short-term treatment. When starting with the data from the CREDO trial, the combination of pre-treatment and prolonged clopidogrel therapy (1 year) was estimated to save €497 and gain 0.10 life-years and 0.14 QALYs per patient. Univariate and probabilistic multivariate sensitivity analyses suggested that the conclusions were generally robust, but that the expected gain in survival for the PCI-CURE population was very sensitive to the effects on mortality within the combined endpoint of myocardial infarction/stroke-free survival. Conclusions: In The Netherlands, pre-treatment plus long-term (9–12 months) therapy with clopidogrel is estimated to save costs and increase (quality-adjusted) survival in the prevention of ischaemic events among patients undergoing elective PCI (CREDO) and in patients with acute coronary syndrome (PCI-CURE) compared with short-term treatment with clopidogrel without pre-treatment. Copyright Adis Data Information BV 2007

Suggested Citation

  • Bart Heeg & Ron Peters & Marc Botteman & Ben Hout, 2007. "Long-Term Clopidogrel Therapy in Patients Receiving Percutaneous Coronary Intervention," PharmacoEconomics, Springer, vol. 25(9), pages 769-782, September.
  • Handle: RePEc:spr:pharme:v:25:y:2007:i:9:p:769-782
    DOI: 10.2165/00019053-200725090-00005
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.2165/00019053-200725090-00005
    Download Restriction: Access to full text is restricted to subscribers.

    File URL: https://libkey.io/10.2165/00019053-200725090-00005?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
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Joel Tsevat & Lee Goldman & Jane R. Soukup & Gervasio A. Lamas & Kathleen F. Connors & Carole C. Chapin & Thomas H. Lee, 1993. "Stability of Time-tradeoff Utilities in Survivors of Myocardial Infarction," Medical Decision Making, , vol. 13(2), pages 161-165, June.
    2. Frank A. Sonnenberg & J. Robert Beck, 1993. "Markov Models in Medical Decision Making," Medical Decision Making, , vol. 13(4), pages 322-338, December.
    3. Anna Ringborg & Peter Lindgren & Bengt Jönsson, 2005. "The cost-effectiveness of dual oral antiplatelet therapy following percutaneous coronary intervention," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(4), pages 354-362, December.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Alexander V van Schoonhoven & Judith J Gout-Zwart & Marijke J S de Vries & Antoinette D I van Asselt & Evgeni Dvortsin & Pepijn Vemer & Job F M van Boven & Maarten J Postma, 2019. "Costs of clinical events in type 2 diabetes mellitus patients in the Netherlands: A systematic review," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-22, September.
    2. J. Logman & Bart Heeg & Johan Herlitz & Ben Hout, 2010. "Costs and consequences of clopidogrel versus aspirin for secondary prevention of ischaemic events in (high-risk) atherosclerotic patients in Sweden," Applied Health Economics and Health Policy, Springer, vol. 8(4), pages 251-265, July.
    3. Elek, Péter & Harsányi, András & Zelei, Tamás & Csetneki, Kata & Kaló, Zoltán, 2017. "Policy objective of generic medicines from the investment perspective: The case of clopidogrel," Health Policy, Elsevier, vol. 121(5), pages 558-565.

    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. Gandjour, Afschin & Stock, Stephanie, 2007. "A national hypertension treatment program in Germany and its estimated impact on costs, life expectancy, and cost-effectiveness," Health Policy, Elsevier, vol. 83(2-3), pages 257-267, October.
    2. Peter Lindgren & Thomas Kahan & Neil Poulter & Martin Buxton & Patrick Svarvar & Björn Dahlöf & Bengt Jönsson, 2007. "Utility loss and indirect costs following cardiovascular events in hypertensive patients: the ASCOT health economic substudy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(1), pages 25-30, March.
    3. Heß, Michael (Ed.) & Schlieter, Hannes (Ed.), 2014. "Modellierung im Gesundheitswesen: Tagungsband des Workshops im Rahmen der Modellierung 2014," ICB Research Reports 57, University Duisburg-Essen, Institute for Computer Science and Business Information Systems (ICB).
    4. Zixian, Liu & Xin, Ni & Yiliu, Liu & Qinglu, Song & Yukun, Wang, 2011. "Gastric esophageal surgery risk analysis with a fault tree and Markov integrated model," Reliability Engineering and System Safety, Elsevier, vol. 96(12), pages 1591-1600.
    5. Mason, J.E. & Denton, B.T. & Shah, N.D. & Smith, S.A., 2014. "Optimizing the simultaneous management of blood pressure and cholesterol for type 2 diabetes patients," European Journal of Operational Research, Elsevier, vol. 233(3), pages 727-738.
    6. Pedram Sendi & Huldrych F Günthard & Mathew Simcock & Bruno Ledergerber & Jörg Schüpbach & Manuel Battegay & for the Swiss HIV Cohort Study, 2007. "Cost-Effectiveness of Genotypic Antiretroviral Resistance Testing in HIV-Infected Patients with Treatment Failure," PLOS ONE, Public Library of Science, vol. 2(1), pages 1-8, January.
    7. Malek B Hannouf & Chander Sehgal & Jeffrey Q Cao & Joseph D Mocanu & Eric Winquist & Gregory S Zaric, 2012. "Cost-Effectiveness of Adding Cetuximab to Platinum-Based Chemotherapy for First-Line Treatment of Recurrent or Metastatic Head and Neck Cancer," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-9, June.
    8. Bärnighausen, Till & Bloom, David E., 2009. ""Conditional scholarships" for HIV/AIDS health workers: Educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa," Social Science & Medicine, Elsevier, vol. 68(3), pages 544-551, February.
    9. Mattias Ekman & Peter Lindgren & Carolin Miltenburger & Genevieve Meier & Julie Locklear & Mary Chatterton, 2012. "Cost Effectiveness of Quetiapine in Patients with Acute Bipolar Depression and in Maintenance Treatment after an Acute Depressive Episode," PharmacoEconomics, Springer, vol. 30(6), pages 513-530, June.
    10. de Wit, G.Ardine & Ramsteijn, Paul G & de Charro, Frank Th, 1998. "Economic evaluation of end stage renal disease treatment," Health Policy, Elsevier, vol. 44(3), pages 215-232, June.
    11. Robert L. Herrick & Steven G. Buchberger & Robert M. Clark & Margaret Kupferle & Regan Murray & Paul Succop, 2012. "A Markov Model To Estimate Salmonella Morbidity, Mortality, Illness Duration, And Cost," Health Economics, John Wiley & Sons, Ltd., vol. 21(10), pages 1169-1182, October.
    12. Afschin Gandjour & Eva-Julia Weyler, 2006. "Cost-effectiveness of referrals to high-volume hospitals: An analysis based on a probabilistic Markov model for hip fracture surgeries," Health Care Management Science, Springer, vol. 9(4), pages 359-369, November.
    13. Malek Ebadi & Raha Akhavan-Tabatabaei, 2021. "Personalized Cotesting Policies for Cervical Cancer Screening: A POMDP Approach," Mathematics, MDPI, vol. 9(6), pages 1-20, March.
    14. Hiral Anil Shah & Tim Baker & Carl Otto Schell & August Kuwawenaruwa & Khamis Awadh & Karima Khalid & Angela Kairu & Vincent Were & Edwine Barasa & Peter Baker & Lorna Guinness, 2023. "Cost Effectiveness of Strategies for Caring for Critically Ill Patients with COVID-19 in Tanzania," PharmacoEconomics - Open, Springer, vol. 7(4), pages 537-552, July.
    15. Gabriel Rogers & Ruth Garside & Stuart Mealing & Martin Pitt & Rob Anderson & Matthew Dyer & Ken Stein & Margaret Somerville, 2008. "Carmustine Implants for the Treatment of Newly Diagnosed High-Grade Gliomas," PharmacoEconomics, Springer, vol. 26(1), pages 33-44, January.
    16. Bart Heeg & Joep Damen & Ben Hout, 2007. "Oral Antiplatelet Therapy in Secondary Prevention of Cardiovascular Events," PharmacoEconomics, Springer, vol. 25(12), pages 1063-1082, December.
    17. Mark Sculpher & David Torgerson & Ron Goeree & Bernie O'Brien, 1999. "A critical structured review of economic evaluations of interventions for the prevention and treatment of osteoporosis," Working Papers 169chedp, Centre for Health Economics, University of York.
    18. Hua Zhang & Mingdong Huo & Jianqian Chao & Pei Liu, 2016. "Application of Bayesian Approach to Cost-Effectiveness Analysis of Antiviral Treatments in Chronic Hepatitis B," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-9, August.
    19. F. Tomini & F. Prinzen & A. D. I. Asselt, 2016. "A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(9), pages 1159-1172, December.
    20. Alan Brennan & Stephen E. Chick & Ruth Davies, 2006. "A taxonomy of model structures for economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 15(12), pages 1295-1310, December.

    More about this item

    Statistics

    Access and download statistics

    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:spr:pharme:v:25:y:2007:i:9:p:769-782. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    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.