Cost-Effectiveness of Clopidogrel plus Aspirin versus Aspirin Alone
Authors: Mark D. Schleinitz, Paul A. Heidenreich
Journal: Annals of Internal Medicine (2005)

Letters20 September 2005Cost-Effectiveness of Clopidogrel plus Aspirin versus Aspirin AloneMark D. Schleinitz, MD, MS and Paul A. Heidenreich, MD, MSMark D. Schleinitz, MD, MSFrom Brown University, Providence, RI 02903, and VA Palo Alto Healthcare System, Palo Alto, CA 94304.Search for more papers by this author and Paul A. Heidenreich, MD, MSFrom Brown University, Providence, RI 02903, and VA Palo Alto Healthcare System, Palo Alto, CA 94304.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-6-200509200-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Rothberg suggests that our analysis would have been stronger if we had used outcome-specific estimates of the efficacy of clopidogrel when added to aspirin. We agree in theory and have used this approach in an analysis of clopidogrel monotherapy (1). The CURE trial (2), however, did not report the numbers of each type of event that made up the composite outcomes. The cardiovascular death rate cited by Rothberg, for example, is itself a composite of deaths due to stroke, myocardial infarction, and other cardiovascular causes. We felt that the potential to introduce bias by estimating event rates ...References1. Schleinitz MD, Weiss JP, Owens DK. Clopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost-effectiveness analysis. Am J Med. 2004;116:797-806. [PMID: 15178495] CrossrefMedlineGoogle Scholar2. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-502. [PMID: 11519503] CrossrefMedlineGoogle Scholar3. Peters RJ, Mehta SR, Fox KA, Zhao F, Lewis BS, Kopecky SL, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation. 2003;108:1682-7. [PMID: 14504182] CrossrefMedlineGoogle Scholar4. Schleinitz MD, Olkin I, Heidenreich PA. Cilostazol, clopidogrel or ticlopidine to prevent sub-acute stent thrombosis: a meta-analysis of randomized trials. Am Heart J. 2004;148:990-7. [PMID: 15632883] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Mark D. Schleinitz, MD, MS; Paul A. Heidenreich, MD, MSAffiliations: From Brown University, Providence, RI 02903, and VA Palo Alto Healthcare System, Palo Alto, CA 94304.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoA Cost-Effectiveness Analysis of Combination Antiplatelet Therapy for High-Risk Acute Coronary Syndromes: Clopidogrel plus Aspirin versus Aspirin Alone Mark D. Schleinitz and Paul A. Heidenreich Cost-Effectiveness of Clopidogrel plus Aspirin versus Aspirin Alone Michael Rothberg Cost-Effectiveness of Clopidogrel plus Aspirin versus Aspirin Alone Peter Eriksson Metrics 20 September 2005Volume 143, Issue 6Page: 464-465KeywordsAntiplatelet therapyAspirinConflicts of interestDeath ratesHemorrhageMyocardial infarction ePublished: 20 September 2005 Issue Published: 20 September 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...