Pharmacoeconomic evaluation acceptability of clopidogrel versus acetylsalicylic acid in patients with cardiovascular disease for stroke prevention in Ukraine

Abstract

Objectives: The results of many clinical trials demonstrate the benefit of longterm antiplatelet therapy in reducing the risk of cardio- and cerebrovascular complications. Both acetylsalicylic acid (ASA) and clopidogrel are effective, but have potentially serious side effects, and clopidogrel is more expensive than ASA. The purpose of the study is to evaluate the pharmacoeconomic acceptance of clopidogrel versus ASA in patients with atherosclerotic vascular disease manifested as either recent ischaemic stroke, recent myocardial infarction, or symptomatic peripheral arterial disease to prevent non-fatal stroke and death rate according to the clinical trial CAPRIE from Ukrainian perspective. Methods: Outcomes of the clinical study CAPRIE, modeling “decision tree” and analysis “cost-effectiveness” were used. Results: The results of the clinical trial CAPRIE study showed, that clopidogrel is more effective versus ASA for reducing the risk of nonfatal stroke: absolute risk reduction is -2.7%. Model “decision tree” was built using the probabilities of events (nonfatal stroke and death) from the study CAPRIE. Direct costs were calculated taking into account the costs of antiplatelet therapy, of nonfatal stroke treatment (drugs, diagnosis, patient’s stay in hospital) and the cost of rehabilitation after stroke. Indirect costs are not taken into account because the patients were of retirement age (62.5 years old). As a result of calculations it was found, that antiplatelet therapy with clopidogrel is more expensive and more effective (2 additional lives saved per 1000 patients over 1.91 years) compared with ASA. Due to the threshold of society “willingness to pay” per 1 life saved, or 1 QALY, use of clopidogrel as antiplatelet agent in patients with cardiovascular disease is economically profitable for Ukraine. Conclusions: The use of clopidogrel as an antiplatelet agent in patients with cardiovascular disease to prevent nonfatal stroke compared to the ASA is economically profitable for Ukraine.