Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention

Hwang, Doyeon; Kim, Hea-Lim; Koo, Bon‐Kwon; Rhee, Tae‐Min; Yang, Dongwook; Seo, Yongwon; Byun, Joonsoo; Kang, Jeehoon; Han, Jung‐Kyu; Park, Kyung Woo; Shin, Eun‐Seok; Rha, Seung–Woon; Bae, Jang‐Whan; Mamas, Mamas A.; Cohen, David J.; Lee, Tae-Jin; Kim, Hyo–Soo

doi:10.1016/j.jacasi.2022.12.007

JACC: Asia

2023

DOI: 10.1016/j.jacasi.2022.12.007

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Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention

Doyeon Hwang

Hea-Lim Kim

Bon‐Kwon Koo

et al.

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Cited by 5 publications

(16 citation statements)

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“…These investigators found that the positive impact of clopidogrel monotherapy in the composite clinical results did not translate into a rise in quality-adjusted life-years. 3 Cardiac mortality was numerically greater in the clopidogrel group than in the aspirin group. 3 With clopidogrel monotherapy, health care expenses climbed in Korea but were reduced in the United Kingdom and the United States.…”

mentioning

confidence: 96%

“… 3 Cardiac mortality was numerically greater in the clopidogrel group than in the aspirin group. 3 With clopidogrel monotherapy, health care expenses climbed in Korea but were reduced in the United Kingdom and the United States. 3 These discrepancies were mostly attributable to disparities in health care systems, costs associated with unfavorable clinical outcomes, and medication pricing.…”

mentioning

confidence: 96%

“…In this issue of JACC: Asia , Koo et al 3 report on their cost-effectiveness analysis of the HOST-EXAM study in 3 health care systems (Korea, the United States, and the United Kingdom). These investigators found that the positive impact of clopidogrel monotherapy in the composite clinical results did not translate into a rise in quality-adjusted life-years.…”

mentioning

confidence: 99%

“… 3 With clopidogrel monotherapy, health care expenses climbed in Korea but were reduced in the United Kingdom and the United States. 3 These discrepancies were mostly attributable to disparities in health care systems, costs associated with unfavorable clinical outcomes, and medication pricing. 3 Under the assumption of no variability in cardiac death, the scenario-based assessment revealed that clopidogrel monotherapy was not cost-effective in Korea.…”

mentioning

confidence: 99%

“… 3 These discrepancies were mostly attributable to disparities in health care systems, costs associated with unfavorable clinical outcomes, and medication pricing. 3 Under the assumption of no variability in cardiac death, the scenario-based assessment revealed that clopidogrel monotherapy was not cost-effective in Korea. However, it may be the dominant therapeutic approach in the United Kingdom and the United States.…”

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confidence: 99%

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Challenging the “Divinity” of Aspirin Monotherapy for Secondary Prevention of Cardiovascular Disease

Spartalis

Siasos

2023

JACC: Asia

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mentioning

confidence: 96%

mentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Challenging the “Divinity” of Aspirin Monotherapy for Secondary Prevention of Cardiovascular Disease

Spartalis

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2023

JACC: Asia

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Cost-Effectiveness of Fractional Flow Reserve–Guided Treatment for Acute Myocardial Infarction and Multivessel Disease

Hong,

Lee,

Lee

et al. 2024

JAMA Netw Open

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ImportanceComplete revascularization by non–infarct-related artery (IRA) percutaneous coronary intervention (PCI) in patients with acute myocardial infarction is standard practice to improve patient prognosis. However, it is unclear whether a fractional flow reserve (FFR)–guided or angiography-guided treatment strategy for non-IRA PCI would be more cost-effective.ObjectiveTo evaluate the cost-effectiveness of FFR-guided compared with angiography-guided PCI in patients with acute myocardial infarction and multivessel disease.Design, Setting, and ParticipantsIn this prespecified cost-effectiveness analysis of the FRAME-AMI randomized clinical trial, patients were randomly allocated to either FFR-guided or angiography-guided PCI for non-IRA lesions between August 19, 2016, and December 24, 2020. Patients were aged 19 years or older, had ST-segment elevation myocardial infarction (STEMI) or non-STEMI and underwent successful primary or urgent PCI, and had at least 1 non-IRA lesion (diameter stenosis &gt;50% in a major epicardial coronary artery or major side branch with a vessel diameter of ≥2.0 mm). Data analysis was performed on August 27, 2023.InterventionFractional flow reserve–guided vs angiography-guided PCI for non-IRA lesions.Main Outcomes and MeasuresThe model simulated death, myocardial infarction, and repeat revascularization. Future medical costs and benefits were discounted by 4.5% per year. The main outcomes were quality-adjusted life-years (QALYs), direct medical costs, incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INB) of FFR-guided PCI compared with angiography-guided PCI. State-transition Markov models were applied to the Korean, US, and European health care systems using medical cost (presented in US dollars), utilities data, and transition probabilities from meta-analysis of previous trials.ResultsThe FRAME-AMI trial randomized 562 patients, with a mean (SD) age of 63.3 (11.4) years. Most patients were men (474 [84.3%]). Fractional flow reserve–guided PCI increased QALYs by 0.06 compared with angiography-guided PCI. The total cumulative cost per patient was estimated as $1208 less for FFR-guided compared with angiography-guided PCI. The ICER was −$19 484 and the INB was $3378, indicating that FFR-guided PCI was more cost-effective for patients with acute myocardial infarction and multivessel disease. Probabilistic sensitivity analysis showed consistent results and the likelihood iteration of cost-effectiveness in FFR-guided PCI was 97%. When transition probabilities from the pairwise meta-analysis of the FLOWER-MI and FRAME-AMI trials were used, FFR-guided PCI was more cost-effective than angiography-guided PCI in the Korean, US, and European health care systems, with an INB of $3910, $8557, and $2210, respectively. In probabilistic sensitivity analysis, the likelihood iteration of cost-effectiveness with FFR-guided PCI was 85%, 82%, and 31% for the Korean, US, and European health care systems, respectively.Conclusions and RelevanceThis cost-effectiveness analysis suggests that FFR-guided PCI for non-IRA lesions saved medical costs and increased quality of life better than angiography-guided PCI for patients with acute myocardial infarction and multivessel disease. Fractional flow reserve–guided PCI should be considered in determining the treatment strategy for non-IRA stenoses in these patients.Trial RegistrationClinicalTrials.gov Identifier: NCT02715518

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Role of Cyp2c19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention

Rajachandran,

Lange

2024

Curr Cardiol Rep

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Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention

Cited by 5 publications

References 18 publications

Challenging the “Divinity” of Aspirin Monotherapy for Secondary Prevention of Cardiovascular Disease

Challenging the “Divinity” of Aspirin Monotherapy for Secondary Prevention of Cardiovascular Disease

Cost-Effectiveness of Fractional Flow Reserve–Guided Treatment for Acute Myocardial Infarction and Multivessel Disease

Role of Cyp2c19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention

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