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.