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Cost-effectiveness of oral antiplatelet agents—current and future perspectives

Nature Reviews Cardiology volume 8, pages 580–591 (2011)Cite this article

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Abstract

Cardiovascular disease is both highly prevalent and exceedingly costly to treat. Several novel antiplatelet agents have been found to be effective in reducing the morbidity and mortality associated with cardiovascular disease. Understanding both the economic and the clinical implications of these novel therapies is particularly important. In this article, the results of published evaluations of the cost-effectiveness of oral antiplatelet strategies for use across a range of clinical conditions and treatment settings are reviewed. The results of these studies support the use of aspirin for primary prevention in high-risk patients and for secondary prevention in all patients with previous cardiovascular events. Although the optimal duration of dual antiplatelet therapy after an event remains uncertain, favorable cost-effectiveness estimates have been demonstrated for aspirin plus clopidogrel versus aspirin alone after a myocardial infarction or percutaneous coronary intervention. Moreover, prasugrel has been shown to be more cost-effective than clopidogrel for patients with an acute coronary syndrome and planned percutaneous coronary intervention. As novel antiplatelet agents emerge and existing agents are tested in different patient populations, the evaluation of the relative economic efficiency of these oral antiplatelet treatment strategies will continue to be instrumental to optimally inform clinical and health-policy decision-making.

Key Points

  • The cost-effectiveness of novel compared with standard antiplatelet therapies depends on the balance between risk of ischemic events and bleeding complications, and the impact on clinical effectiveness and costs

  • Low-dose aspirin is economically favorable for primary prevention of cardiovascular disease when the 10-year risk of ischemic events is ≥7.5%, and in all patients after an ischemic cardiovascular event

  • In patients with cerebrovascular disease, either clopidogrel monotherapy or aspirin plus dipyridamole are economically favorable treatment strategies when compared with aspirin alone

  • After a myocardial infarction or percutaneous coronary intervention, aspirin plus clopidogrel is economically favorable compared with aspirin alone

  • Aspirin plus prasugrel is even more economically attractive than aspirin plus clopidogrel in patients with an acute coronary syndrome and planned percutaneous coronary intervention

  • Dual antiplatelet therapy is not cost-effective compared with aspirin alone in the treatment of chronic, stable coronary artery disease, primarily because of the low underlying risk of adverse ischemic events

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  1. Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, 64111, MO, USA

    Suzanne V. Arnold, David J. Cohen & Elizabeth A. Magnuson

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Contributions

S. Arnold and E. A. Magnuson researched the data for this article, and all the authors discussed its content. S. Arnold and E. A. Magnuson wrote the article, and all the authors reviewed and edited the manuscript before submission.

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Correspondence to Elizabeth A. Magnuson.

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Competing interests

D. J. Cohen has received grants or research support from the following companies: Abbott Vascular, Accumetrics, Boston Scientific, Bristol-Myers Squibb, Condis, Daiichi Sankyo, Edwards Lifesciences, Lilly, The Medicines Company, Medrad, Medtronic, Merck, and Sanofi-Aventis. D. J. Cohen has also received honoraria from Lilly and The Medicines Company, and has been a consultant for Condis, Lilly, Medtronic, and Merck. E. A. Magnuson has received grant or research support from the following companies: Bristol-Myers Squibb, Daiichi Sankyo, Lilly, and Sanofi-Aventis, and has received honoraria from Bristol-Myers Squibb and Sanofi-Aventis. S. V. Arnold declares no competing interests.

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Arnold, S., Cohen, D. & Magnuson, E. Cost-effectiveness of oral antiplatelet agents—current and future perspectives. Nat Rev Cardiol 8, 580–591 (2011). https://doi.org/10.1038/nrcardio.2011.119

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