Cost-Effectiveness of Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention in India.

OBJECTIVES

Evidence suggests that ticagrelor is more effective and cost-effective than clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention. In India, clopidogrel is widely prescribed for these patients. This study aimed to evaluate the cost-effectiveness of clopidogrel in the said population in India.

METHODS

We developed a 2-part model (a short-term decision tree and a long-term Markov model) with a lifetime horizon to compare cost-effectiveness of clopidogrel (75 mg) and ticagrelor (90 mg) from the healthcare and societal perspectives. Uncertainty was assessed using both one-way and probabilistic sensitivity analysis. Three scenarios were analyzed: (1) using clinical data from the Platelet Inhibition and Patient Outcomes trial, (2) using clinical data from the Dose confirmation Study assessing anti-Platelet Effects of AZD6140 vs clopidogrel in non-ST-segment Elevation myocardial infarction (DISPERSE) trial, and (3) using costs of generic drugs instead of branded drugs.

RESULTS

Clopidogrel resulted in lower costs (US$34 877) and lower quality-adjusted life-years (23.94), compared with ticagrelor. Clopidogrel represents a lower cost but less effective alternative, indicating a cost-effectiveness trade-off rather than dominance. As the willingness-to-pay threshold increases, the probability of clopidogrel being cost-effective decreases, whereas that of ticagrelor increases. The results were robust for all sensitivity analyses conducted.

CONCLUSIONS

Clopidogrel treatment had lower costs and effectiveness than ticagrelor. The preferred treatment depends on the willingness to pay and whether the additional quality-adjusted life-years justify higher costs. The findings can facilitate clinicians and healthcare decision makers in India and similar settings, helping optimize healthcare resource allocation.