Using Clopidogrel in Non-ST-Segment Elevation Acute Coronary Syndrome Patients: A Cost-Utility Analysis in Spain

Abstract

Objective: The objective of this study was to estimate the cost-effectiveness of clopidogrel, administered for 1 year after hospital admission for non-ST-segment elevation acute coronary syndrome in the Spanish public health network. Methods: A cost-utility analysis was conducted from the societal perspective. A Markov decision tree was constructed for modeling the long-term cardiovascular events according to the probabilities of the CURE study, the Framingham study, and the Spanish age-sex-specific mortality rates. The costs of the therapy were calculated mainly using the cost per diagnosis-related group in the Spanish National Health System. The utilities of the various states were estimated using data from published studies. A 3% discount rate was used for both the costs and the utilities. An expected value sensitivity analysis and a Monte Carlo microsimulation probabilistic analysis were performed. Results: The cost per quality-adjusted life-year (QALY) saved owing to clopidogrel in the base case was about ε12,000. This expected cost-effectiveness ratio was very sensitive to the age of the patient, the base risk of cardiovascular events, and the precision of the estimated effectiveness of clopidogrel. The cost per QALY ranged between some ε5,000 for a high-risk, 40-year-old patient and ε30,000 for a low-risk, 80-year-old patient. According to the accepted threshold for Spanish society, the probability that clopidogrel was cost-effective in the base analysis case was 85.3%. Conclusions: By Spanish standards, the use of clopidogrel in patients with non-ST-segment elevation acute coronary syndrome is cost-effective, at least when used for patients at high risk of presenting cardiovascular events.