Cost Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart Disease

Aspirin and clopidogrel, alone or together, reduce the rate of cardiovascular events in patients with coronary disease, but their relative cost effectiveness is uncertain. In this study, the use of aspirin in all patients eligible to receive it was very cost effective. In contrast, clopidogrel as a substitute for or in addition to aspirin was not cost effective. At its current price, clopidogrel was cost effective only when used in the small number of patients who cannot take aspirin. For patients with prior myocardial infarction, prior stroke, or other high-risk vascular conditions, antiplatelet therapy reduces the rate of myocardial infarction, stroke, or death from vascular causes by about 30 percent. 1 Despite abundant data and numerous recommendations, the use of aspirin for patients with coronary heart disease has lagged, although its use increased to about 85 percent of patients discharged after acute myocardial infarction by 1999. 2 – 15 Clopidogrel, a thienopyridine derivative, was shown to reduce the relative risk of ischemic stroke, myocardial infarction, or death from vascular causes in patients with prior cardiovascular disease by 8.7 percent as compared with . . .