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Type: Journal article
Title: Modelling the long term cost effectiveness of clopidogrel for the secondary prevention of occlusive vascular events in the UK
Author: Karnon, J.
Brennan, A.
Pandor, A.
Fowkes, G.
Lee, A.
Gray, D.
Coshall, C.
Nicholls, C.
Akehurst, R.
Citation: Current Medical Research and Opinion, 2005; 21(1):101-112
Publisher: Librapharm
Issue Date: 2005
ISSN: 0300-7995
Statement of
Karnon Jon, Brennan Alan, Pandor Abdullah , Fowkes Gerry, Lee Amanda, Gray David, Coshall Catherine, Nicholls Charles and Akehurst Ron
Abstract: Objective: To assess the long term cost effectiveness of clopidogrel monotherapy compared with acetylsalicylic acid (aspirin; ASA) monotherapy in patients at risk of secondary occlusive vascular events (OVEs) in the UK. Design: Cost utility analysis based on clinical data from CAPRIE (a multicentre randomised controlled trial, involving 19185 patients); long-term effects were extrapolated beyond the trial period using a Markov model populated with data from UK observational studies. Health economic evaluation carried out from the perspective of the UK National Health Service. Participants: A representative cohort of 1000 UK patients aged 60 years (approximate mean age of the CAPRIE population), with the qualifying diagnoses of myocardial infarction, ischaemic stroke and peripheral arterial disease, who are at risk of secondary OVEs (non-fatal myocardial infarction, non-fatal stroke or vascular death). Interventions: Patients were assumed to receive treatment with either clopidogrel (75 mg/day) for 2 years followed by ASA (325 mg/day, average) for their remaining lifetime, or ASA alone (325 mg/day, average) for life. Main outcome measures: Incremental cost per life year gained and incremental cost per quality-adjusted life year (QALY) gained. Results: In the base case, the incremental cost effectiveness of clopidogrel versus ASA in this population is estimated at £18888 per life year gained and £21489 per QALY gained. Multiple deterministic and probabilistic sensitivity analyses suggest the model is robust to variations in a wide range of input parameters. Conclusion: Two years of treatment with clopidogrel can be considered a cost effective intervention in patients at risk of secondary OVEs in the UK.
Keywords: Humans; Vascular Diseases; Aspirin; Ticlopidine; Platelet Aggregation Inhibitors; Models, Economic; Markov Chains; Quality-Adjusted Life Years; Aged; Middle Aged; Cost-Benefit Analysis; Female; Male; Randomized Controlled Trials as Topic; United Kingdom; Clopidogrel
RMID: 0020081228
DOI: 10.1185/030079904X18036
Appears in Collections:Public Health publications

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