A COST-EFFECTIVENESS ANALYSIS OF CLOPIDOGREL FOR PATIENTS WITH NON-ST-SEGMENT EVALUATION ACUTE CORONARY SYNDROME IN CHINA

Saturday, January 9, 2016
Foyer, G/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

M. Cui1, C.C. Tu2, E.Z. Chen3, X.L. Wang4, Seng Chuen Tan, MSc5 and C. Chen5, (1)Peking University Third Hospital, Beijing, China, (2)Beijing Anzhen Hospital, Capital Medical University, Haidan, Beijing, China, (3)Shanghai Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Xuhui, Shanghai, China, (4)China-Japan Friendship Hospital, Chaoyang, Beijing, China, (5)IMS Consulting Group, Asia Pacific, Singapore, Singapore, Singapore
Purpose:

   There are number of economic evaluation studies of clopidogrel for patients with non-ST-segment -elevation ACS published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost-effectiveness for up to 1 year’s treatment with clopidogrel plus aspirin versus aspirin alone for non-ST-segment -elevation ACS, from the public payer perspective in China.

Method(s):

   This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon. Based on the primary event rates, adherence rate and mortality derived from the CURE trial, hazard functions obtained from published literature were used to extrapolate the overall survival to lifetime horizon. Resource utilization, hospitalization, medication costs and utility values were estimated from official reports, published literature and analysis of the patient level insurance data in China. To assess the impact of parameters’ uncertainty on cost-effectiveness results, one-way sensitivity analyses were undertaken for key parameters and probabilistic sensitivity analysis (PSA) was conducted using Monte-Carlo simulation.

Result(s):

The therapy of clopidogrel plus aspirin is a cost-effective option in comparison to aspirin alone for the treatment of non-ST-segment -elevation ACS in China, leading to 0.0548 LYs and 0.0518 QALYs gained per patient. From the public payer perspective in China, clopidogrel plus aspirin is associated with an incremental cost of 43,340 Renminbi (RMB) per QALY gained and 41,030 RMB per LY gained (discounting at 3.5% per year). PSA results demonstrated that 88% of simulations were lower than the cost-effectiveness threshold of 150,721 RMB per QALY gained. Based on the one-way sensitivity analysis, results are most sensitive to price of clopidogrel, but remain well below this threshold.

 

Conclusion(s):

This analysis suggests that treatment with clopidogrel plus ASA for up-to-1-year for patients with non-ST-segment elevation ACS is cost-effective in the local context of China from a public payers’ perspective.

 

　

Clopidogrel+ASA

ASA

Lifetime Cost (RMB)

¥43,962

¥41,715

Life Years (LY) Gained

7.52

7.47

QALYs Gained

6.82

6.77

Incremental Cost

¥2,247

Incremental LYs

0.0548

Incremental QALYs

0.0518

Incremental Cost per LY Gained

¥41,030

Incremental Cost per QALY Gained

¥43,340

Disclosure: This study was funded by Sanofi China.

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