Cost-Effectiveness of Clopidogrel: Seeing through the Smoke

Lee Goldman and Jean-Michel Gaspoz
Additional contact information
Lee Goldman: Columbia University College of Physicians and Surgeons, New York
Jean-Michel Gaspoz: Department of Community Medicine and Primary Care, Geneva University Hospitals and University of Geneva, Geneva, Switzerland, jean-michel.gaspoz@hcuge.ch

Medical Decision Making, 2008, vol. 28, issue 6, 803-809

Abstract: Background . A recent article in this journal raised specific questions about the authors' methods for modeling the cost-effectiveness of clopidogrel for secondary prevention of coronary heart disease. The key issues raised were inclusion of incident cases, time horizon, and use of an inclusive model structure. Methods . The authors reviewed various recommendations and practices for cost-effectiveness analysis. They also performed a PubMed search for clopidogrel and cost-effectiveness from 2004 to early 2008 to obtain original analyses published in English to look for possible associations of assumptions and conclusions with reported pharmaceutical support. Results . Inclusion of incident cases and truncation at a sensible follow-up time more appropriately reflect the burden to be assumed by third-party payers. Extending the time horizon too far runs the risk of decreasing any relation with future reality. Parsimony cannot justify simplifications that omit relevant issues such as noncoronary costs, which worsen the calculated cost-effectiveness ratio of clopidogrel by 5% to 27%. The choice of the population to be analyzed has a major effect on cost-effectiveness: pharmaceutically sponsored studies published between 2004 and early 2008 focused on high-risk patients and have routinely shown more favorable cost-effectiveness ratios for clopidogrel than studies without pharmaceutical support. Conclusion . Any entity hoping to make the cost-effectiveness ratio of clopidogrel look more favorable would prefer the isolated, cohort approach and limit the analysis to high-risk patients most likely to benefit from it. This approach ignores the reality of medical policies and does not address the most relevant questions regarding the optimum use of clopidogrel.

Keywords: cost-effectiveness; antiplatelet drugs; models; pharmaceutical support (search for similar items in EconPapers)
Date: 2008
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X08318467 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:28:y:2008:i:6:p:803-809

DOI: 10.1177/0272989X08318467

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().