Clopidogrel versus aspirin in patients with atherothrombosis: CAPRIE-based calculation of cost-effectiveness for Germany

Abstract

The findings for Germany are in line with published results for Belgium (euro13 390 per LYS) and also with results for Italy (euro17 500 per LYS), both based on Saskatchewan data, and with a French analysis based on Framingham data (euro15 907 per LYS). Even if no officially accepted cost-effectiveness threshold exists for Germany at present, incremental cost-effectiveness results of less than euro20 000 per LYS for the treatment with clopidogrel can be assumed to be acceptable for German third party payers.

Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (review of Technology Appraisal No. 90): a systematic review and economic analysis

“…Of the 34 potentially relevant studies, 11 [69][70][71][72][73][74][75][76][77][78][79] met the criteria for inclusion in the cost-effectiveness review; one study 69 was also included in the SR that informed the previous guidance. 24 Of the 11 [69][70][71][72][73][74][75][76][77][78][79] included studies, seven [69][70][71][72][73][74][75] were published in full, whereas four 76-79 were available only in an abstract format. Most of the studies were of reasonable quality; however, more detail and focused critique of the clinical effectiveness evidence used to inform the economic evaluations would have improved the quality of the studies (see Appendix 2).…”

“…Only four studies 70,73,77,78 described a UK population. Most of the studies adopted a lifetime perspective; however, four 69,71,72,77 adopted a short-term perspective (e.g. duration of the clinical study follow-up).…”

“…Matchar et al 74 used an individual sampling model based on a model previously developed for the secondary prevention of stroke. Berger et al 71 adapted the model developed by Annemans et al 69 and Beard et al 70 based their model on the model developed by Cambers et al 81 All relevant assumptions and extra information describing the models are summarised in Table 28.…”

“…Drugs costs have been taken from a variety of different sources including local cost lists; 69 published literature; 71 the BNF; 70,73 and the WEB of pharmacy wholesale suppliers. 74,75 Costs of acute events, including hospitalisations and acute care, have been taken from the trial-based papers, 71,73 Medicare diagnosis-related groups data, 74,75 NHS Trust Financial Return data 70 and the published literature. 71,78 Only three papers 76,77,79 do not state the sources of the cost data used.…”

“…Five 69,71,72,74,76 of the 11 69-79 studies included were described as cost-effectiveness analyses and six 70,73,75,[77][78][79] as cost-utility analyses. The cost-effectiveness analyses have used a range of health outcomes including life saved, events avoided, life-years lived, time spent free of stroke recurrence or disability and life expectancy.…”