Researchers at Emory University have determined that a common medication given to prevent heart attacks and stroke is highly cost-effective for those who have suffered a less-damaging type of heart attack, while it is also effective in preventing another episode from occurring. The medication, clopidogrel (brand name Plavix), is expensive, but because of its life-saving benefits, researchers believe it provides good value. Their results will be published in the Journal of the American College of Cardiology (JACC) on Tuesday, March 15.
People who have had a heart attack or stroke are more likely to have clots form in their arteries. These clots can limit or stop the flow of blood to vital areas in the body. A clot in a coronary artery can lead to a heart attack. A clot in a cerebral (brain) artery can lead to a stroke. Clopidogrel works by helping to keep platelets (cell-like particles that assist in the clotting of blood) in the blood from sticking together and forming clots.
"Based on previous studies, clopidogrel has been shown to prevent future heart attacks in patients," says William Weintraub, MD, professor in the Department of Medicine, Division of Cardiology, Emory University School of Medicine, and lead investigator of the study. "So we wanted to find: Is it cost-effective to take clopidogrel up to one year after a coronary event? And how much will it cost to extend lives in relation to the cost of the medication?"
The researchers used data from a previous study called CURE, or Clopidogrel in Unstable angina to prevent Recurrent Events, which evaluated the safety and effectiveness of the medication. From December 1998 to September 2000, 12,562 participants from 28 countries were recruited for the CURE trial. The participants, who either had unstable angina or a non-ST-segment elevation heart attack (a heart attack in only the inner wall of the heart, causing less damage than a major heart attack through the heart muscle from inner to outer surface), were randomly selected to receive clopidogrel (loading dose of 300 mg followed by 75 mg per day) plus aspirin or aspirin alone.
Participants took the medications for up to one year (average of nine months) after a heart event. The CURE results showed the use of clopidogrel for up to one year after a heart event reduced the risk of cardiovascular death, heart attack and stroke.
"We used this same group of people to then evaluate the long-term cost-effectiveness of clopidogrel by translating the reduced number of primary fatal and non-fatal events observed in the CURE trial into estimates of gains in life expectancy," says Dr. Weintraub. "Ultimately, these figures helped us determine the costs of saving a year of life with clopidogrel."
Excluding the costs of purchasing clopidogrel, average costs of hospitalizations alone were $325 lower per person in the clopidogrel arm. But when costs of purchasing the drug were added in, average total costs were $442 higher per person in the clopidogrel arm.
"For patients with acute coronary syndromes, we found anti-platelet therapy using clopidogrel is not only cost-effective, but also beneficial in preventing future heart attacks and stroke," Dr. Weintraub explains. "Our study shows that this drug can help prevent big coronary events, help some patients to live longer, and it is cost-effective. Many physicians resist prescribing this medication due to expense. I hope they see the results of this study and realize it is a life-saving, cost-worthy therapy."
The maker of clopidogrel, Sanofi-Aventis, sponsored this study. Dr. Weintraub has served as a consultant to Sanofi-Aventis, as well as received research-funding support from the company.
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