Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention: Results From the HOST-EXAM Study

Doyeon Hwang; Hea-Lim Kim; Bon-Kwon Koo; Tae-Min Rhee; Dong-Wook Yang; Youngwon Seo; Joonsoo Byun; Jeehoon Kang; Jung-Kyu Han; Kyung Woo Park; Eun-Seok Shin; Seung-Woon Rha; Jang-Whan Bae; Mamas A Mamas; David J Cohen; Tae-Jin Lee; Hyo-Soo Kim; HOST-EXAM Investigators

doi:10.1016/j.jacasi.2022.12.007

Cost-Effectiveness of Clopidogrel vs Aspirin Monotherapy After Percutaneous Coronary Intervention: Results From the HOST-EXAM Study

JACC Asia. 2023 Mar 14;3(2):198-207. doi: 10.1016/j.jacasi.2022.12.007. eCollection 2023 Apr.

Authors

Doyeon Hwang¹, Hea-Lim Kim^{2

3}, Bon-Kwon Koo¹, Tae-Min Rhee¹, Dong-Wook Yang³, Youngwon Seo², Joonsoo Byun², Jeehoon Kang¹, Jung-Kyu Han¹, Kyung Woo Park¹, Eun-Seok Shin⁴, Seung-Woon Rha⁵, Jang-Whan Bae⁶, Mamas A Mamas⁷, David J Cohen^{8

9}, Tae-Jin Lee^{2

3}, Hyo-Soo Kim¹; HOST-EXAM Investigators

Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
² Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
³ Institute of Health and Environment, Seoul National University, Seoul, South Korea.
⁴ Department of Cardiology, Ulsan University Hospital, Ulsan, South Korea.
⁵ Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea.
⁶ Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk, South Korea.
⁷ Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom.
⁸ Cardiovascular Research Foundation, New York, New York, USA.
⁹ St. Francis Hospital, Roslyn, New York, USA.

Abstract

Background: The HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Disease-Extended Antiplatelet Monotherapy) trial showed superior efficacy and safety of clopidogrel monotherapy compared with aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention (PCI).

Objectives: The goal of this study was to investigate the cost-effectiveness of clopidogrel monotherapy compared with that of aspirin monotherapy.

Methods: A Markov model was developed for patients in the stable phase after PCI. From the perspectives of the South Korean, UK, and U.S. health care systems, the lifetime health care costs and quality-adjusted life-years (QALYs) of each strategy were estimated. Transition probabilities were obtained from the HOST-EXAM trial, and health care costs and health-related utilities were obtained from data and literature for each country.

Results: From the perspective of the South Korean health care system, the base-case analysis showed that clopidogrel monotherapy was $3,192 higher in lifetime health care costs and 0.139 lower in QALYs compared with aspirin. This result was greatly influenced by the numerically but insignificantly higher cardiovascular mortality of clopidogrel compared with aspirin. In the analogous UK and U.S. models, clopidogrel monotherapy was projected to decrease health care costs by £1,122 and $8,920 per patient compared with aspirin monotherapy while reducing QALYs by 0.103 and 0.175, respectively.

Conclusions: Based on empirical data from the HOST-EXAM trial, clopidogrel monotherapy was projected to lead to reduced QALYs compared with aspirin during the chronic maintenance period after PCI. These results were affected by a numerically higher rate of cardiovascular mortality in clopidogrel monotherapy reported from the HOST-EXAM trial. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250).

Keywords: aspirin; clopidogrel; coronary artery disease; cost-effectiveness; percutaneous coronary intervention.

Associated data

ClinicalTrials.gov/NCT02044250