Untitled

Issue 2005/13
Title Clinical
Eff ectiveness and Cost-eff ectiveness of Clopidogrel and Modifi ed-
release Dipyridamole in the Secondary Prevention of Occlusive Vascular
Events: A Systematic Review and Economic Evaluation
Agency
NCCHTA, National Coordinating Centre for Health Technology Assessment
Mailpoint 728, Boldrewood, University of Southampton, Southampton
SO16 7PX, United Kingdom; Tel: +44 2380 595586, Fax: +44 2380 595639
Reference
Health Technol Assess 2004;8(38). Oct 2004. www.ncchta.org/execsumm/summ838.htm MR-dipyridamole treatment groups experienced head- To examine the clinical and cost eff ectiveness of 2 alterna- aches compared to patients receiving aspirin alone. Th tive antiplatelet agents, clopidogrel and modifi ed-release York model assessed, under several diff erent scenarios, (MR)-dipyridamole, relative to prophylactic doses of as- the cost eff ectiveness of diff ering combinations of treat- pirin for the secondary prevention of occlusive vascular ment strategies in 4 patient subgroups. Th the model were sensitive to the assumptions made in the alternative scenarios, in particular the impact of therapy Conclusions and results
In the CAPRIE trial, the point estimate for the primary Recommendations
outcome, ie, ischemic stroke, myocardial infarction (MI), or vascular death, favored clopidogrel over aspirin, but Please see the full monograph for recommendations.
the boundaries of the confi dence intervals raise the possi- bility that clopidogrel is not more benefi cial than aspirin. Regarding secondary outcomes, a non-signifi cant trend Please see the full monograph for methods.
Further research/reviews required
reporting bleeding disorders in the clopidogrel group did not diff er from the aspirin group. Th Evaluation of the combination of clopidogrel and aspirin rash and diarrhea were statistically signifi cantly higher (for secondary prevention of occlusive vascular events). in the clopidogrel group than the aspirin group. Th Randomized, direct comparisons of clopidogrel and aspirin group had a higher incidence of indigestion/nau- MR-dipyridamole in combination with aspirin (to in- sea/vomiting than the clopidogrel group. Hematological form treatment of patients with a history of stroke and adverse events were rare in both groups. No cases of TIA). Trials to compare treatment with clopidogrel and thrombotic thrombocytopenic purpura were reported MR-dipyridamole (for secondary prevention of vascular in either group. Treatment with MR-dipyridamole alone events in patients demonstrating genuine intolerance to did not signifi cantly reduce the risk of any of the primary outcomes reported in ESPS-2 compared with treatment with aspirin. Acetylsalicylic acid (ASA)–MR-dipyridam-ole was signifi cantly more eff ective than aspirin alone in patients with stroke or transient ischemic attacks (TIAs) at reducing the outcome of stroke and marginally more eff ective at reducing stroke and/or death. ASA–MR-di-pyridamole did not statistically signifi cantly reduce the risk of death compared to aspirin. Th was statistically signifi cantly reduced in the ASA–MR-dipyridamole group versus the MR-dipyridamole group. Results in the other primary outcomes, stroke and/or death, and death, favored ASA–MR-dipyridamole, but the fi ndings were not statistically signifi cant. Th ber of bleeding complications did not diff er between the groups, but the incidence was signifi cantly lower in the MR-dipyridamole group. More patients in the Written by Ms Lisa Jones and Dr Rob Riemsma, CRD, UK INAHTA Brief Compilation – Volume 5

Source: http://inahta.episerverhotell.net/upload/Briefs_5/0513_NCCHTA_Clopidogrel_ModifiedRelease_Dipyridamole_Secondary_Prevention_Occlusive_Vascular_Events.pdf