"We have three separate investigations showing uniform results in both the short and long-term use of clopidogrel. Specifically, the use of clopidogrel in addition to aspirin produces a significant risk reduction in recurrent heart attack, stroke or cardiovascular death," says William Weintraub, M.D. FACC, Director, Emory Center for Outcomes Research in the Division of Cardiology, Department of Medicine, Emory University School of Medicine, who presented the data. "The study findings and the cost-effectiveness data suggest that at least one year of therapy with clopidogrel is an attractive value. In fact, we believe it should be the standard of care for this patient population."
The Emory University investigators analyzed the drug's cost-effectiveness ratio in two major clinical studies -- the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial and the CREDO (Clopidogrel for the Reduction of Events During Observation) trial -- as well as a substudy of CURE, called PCI-CURE . Cost-effectiveness ratio is the incremental cost of using an intervention to obtain a unit of effectiveness (such as dollars per life-year gained) compared to another treatment or no treatment.
Based on CURE, the Emory researchers found that the cost-effectiveness ratio was $6,173 per life year gained. PCI-CURE, which evaluated people who received clopidogrel for up to one year after having an angioplasty or stent, demonstrated a cost-effectiveness ratio of $5,910 per life year gained. In CREDO, patients were given a dose of clopidogrel before having an angioplasty or stenting procedures and continued on clopidogrel therapy for up to one year. The cost-effectiveness ratio in the CREDO trial was $3,685 per life year gained.
"In health economics, $50,000 per life year gained is considered an acceptable cost-effectiveness ratio," said Dr. Weintraub. "In this analysis of the CURE data, we found that we're nearly 10-fold below the generally accepted cost-effectiveness ratio -- which is a very important and dramatic finding. The data we presented clearly demonstrates that clopidogrel is a very good value for patients at risk for a recurrent cardiovascular event such as a heart attack or stroke."
Clopidogrel is used in addition to therapies such as aspirin to help keep blood platelets from sticking together to form clots. Clot formation, or thrombosis, is one of the main causes of heart attack and strokes. People who have already had a heart attack, stroke or suffer from poor circulation in the limbs -- peripheral arterial disease -- are all at higher risk for a heart attack or stroke.
According to the American Heart Association (AHA), more than one million Americans each year develop acute coronary syndrome (ACS), which is defined as unstable angina (chest pain) and non Q-wave myocardial infarction (mild heart attack). There are more than 1.4 million hospitalizations for ACS each year. The AHA estimates the cost of cardiovascular disease and stroke in the United States in 2003 to be $351.8 billion.
The Emory Heart Center is comprised of all cardiology services and research at Emory University Hospital (EUH), Emory Crawford Long Hospital (ECLH) Carlyle Fraser Heart Center, the Andreas Gruentzig Cardiovascular Center of Emory University and the Emory Clinic. Ranked in the top ten of U.S. News & World Report's annual survey of the nation's best Heart Centers, the Emory Heart Center has a rich history of excellence in all areas of cardiology - including education, research and patient care. It is also internationally recognized as one of the birthplaces of modern interventional cardiology.