Schleinitz MD, Heidenreich PA: A cost-effectiveness analysis of combination antiplatelet therapy for high-risk acute coronary syndromes: clopidogrel plus aspirin versus aspirin alone. Ann Intern Med 2005;142(4):251-9.
Clopidogrel (Plavix) plus aspirin has been shown to prevent more subsequent vascular events in patients with unstable angina than aspirin alone. Although the cost of this drug combination is usually considered too great to recommend it for use in all patients with coronary disease, it may be cost-effective when used with high-risk patients. The authors carried out a cost-utility analysis comparing 325 mg daily of aspirin alone with a combination of clopidogrel 75 mg and aspirin 325 mg daily for a year followed by aspirin 325 mg daily thereafter. Patients treated with aspirin lived an average of 9.5 quality-adjusted life years after their initial event and incurred costs of $127,700 compared to those treated with combination therapy who lived 9.6 quality-adjusted life years with a lifetime cost of $1,600 more than the aspirin alone group. The authors conclude that for patients with high-risk acute coronary syndromes, a year of therapy with clopidogrel plus aspirin results in greater life expectancy than aspirin alone, at a cost within the traditional limits of cost-effectiveness. The balance between reduced risk for vascular events and increased risks for hemorrhage is critical in determining the relative efficacy and cost-effectiveness. More data about benefits and risk beyond a year is needed before combination therapy beyond a year can be advised.