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Análisis coste-efectividad del uso a largo plazo de clopidogrel en el manejo de los pacientes con infarto agudo de miocardio con elevación del segmento ST en España

  • Max Brosa
  • Héctor Bueno
  • José R. González-Juanatey
  • José L. López-Sendón
  • Vicent Valentín Segura
Artículo de Investigación Original

Resumen

Objetivo: El objetivo del presente estudio es valorar la relación coste-efectivi-dad en España del tratamiento con clopidogrel en pacientes con síndrome coronario agudo con elevación del segmento ST (SCACEST) a corto y largo plazo.

Método: Se ha construido un árbol de decisión combinado con un modelo de Markov. Los datos de efcacia provienen de los ensayos clínicos CLARITY y COMMIT durante el primer mes, y de la cohorte “CAPRIE-like” del estudio CHARISMA (meses 2–12). Los datos de riesgo de muerte, IAM e ictus en población no tratada y los de la supervivencia a largo plazo fueron obtenidos del registro Swedish Hospital Discharge and Cause of Death register. El modelo se ha elaborado siguiendo la perspectiva del fnanciador del sistema sanitario, utilizando datos de costes españoles. La efectividad se ha medido en años de vida ganados (AVG) con clopidogrel. Los costes y efectos se han descontado con una tasa anual del 3%.

Resultados: En dos cohortes de pacientes con las características e incidencia de eventos similares a las de los estudios CLARITY y COMMIT, el tratamiento con clopidogrel hasta un año proporciona 0,166 y 0,217 AV G con un coste adicional de 66 € y 635 € por paciente, respectivamente. Estos resultados dieron lugar a razones de coste por AVG de 397 € y 2.927 € para las cohortes CLARITY y COMMIT. La diferencia en la incidencia de ictus fue más pronunciada en el CLARITY, lo que se traduce en importantes ahorros de costes.

Conclusiones: Considerando que el umbral de coste-efectividad generalmente aceptado en España es de 30.000 €/AVG, el tratamiento con clopidogrel de pacientes con SCACEST es coste-efectivo tanto a corto como largo plazo.

Palabras clave

coste-efectividad clopidogrel infarto de miocardio España 

Abstract

Introduction: We aimed to assess short- and long-term cost-effectiveness of clopidogrel in ST-segment elevation myocardial infarction (STEMI) in Spain.

Method: A combined decision tree and Markov model was constructed. Effcacy data were obtained from CLARITY and COMMIT for the frst month and from the “CAPRIE-like” cohort of CHARISMA trial (months 2–12). Risk estimations of death, myocardial infarction, and stroke in an untreated population and long-term survival after all events were derived from the Swedish Hospital Discharge and Cause of Death register. A payer perspective was chosen for the analysis, using local costs. Effectiveness was measured as the number of life-years gained (LYG) with clopidogrel treatment. Costs and effects were discounted at 3%.

Results: In two patient cohorts with the same characteristics and event rates as in the CLARITY and COMMIT populations, treatment with clopidogrel for up to 1 year resulted in a gain of 0.166 LYG and 0.217 LYG and additional costs of 66 € and 635 € per patient respectively. These fgures yielded a cost per LYG ratio of 397 € and 2,927 € for CLARITY and COMMIT cohorts, respectively. The difference in stroke rates was more pronounced in CLARITY with important cost savings being achieved.

Conclusions: Clopidogrel appeared to be cost-effective in short- and long-term treatment in STEMI patients with predicted ICERs being generally below the accepted threshold value of €30,000/LYG.

Key words

Cost-effectiveness analysis clopidogrel myocardial infarction Spain 

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Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Max Brosa
    • 1
  • Héctor Bueno
    • 2
  • José R. González-Juanatey
    • 3
  • José L. López-Sendón
    • 4
  • Vicent Valentín Segura
    • 5
  1. 1.Oblikue ConsultingS.L. BarcelonaEspaña
  2. 2.Servicio de CardiologíaHospital General Universitario “Gregorio Marañón”MadridEspaña
  3. 3.Servicio de CardiologíaHospital Clínico Universitario de Santiago de CompostelaEspaña
  4. 4.Servicio de CardiologíaHospital Universitario “La Paz”MadridEspaña
  5. 5.Unitat CoronàriaHospital Universitari Dr. PesetValenciaEspaña

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