Early Economic Evaluation of Single Versus Dual Antiplatelet Therapy After Endovascular Revascularization for Peripheral Artery Disease

Abstract

Background: Health economic evaluations are performed in addition to clinical trials to inform decision-making. An early health economic evaluation was conducted to determine the potential cost-effectiveness of dual antiplatelet therapy (DAPT; clopidogrel and low-dose acetylsalicylic acid) versus single antiplatelet therapy (SAPT; clopidogrel) after endovascular revascularization in patients with peripheral artery disease (PAD). Methods: A microsimulation model was developed to estimate incremental costs and quality-adjusted life-years with a lifetime time horizon from a health care perspective. Input for the model was found in literature and based on expert opinion. Threshold, deterministic, probabilistic, sensitivity, and value-of-information analyses were performed. Results: Medication costs of DAPT (€66 yearly) compared to SAPT (€47 yearly) were compensated by a decrease in events. Total costs per patient were estimated at €80 469 and €76 925 (difference -€3 544) and total quality-adjusted life-years 5.42 and 5.51, for SAPT and DAPT respectively. At the assumed probabilities, if DAPT reduces ischemic events by 1%, DAPT will dominate SAPT in patients with PAD after endovascular revascularization even if it increases major bleeding. Conclusion: This early economic evaluation shows that DAPT will dominate SAPT in patients with PAD after endovascular revascularization at a small decrease in major adverse cardiovascular events and major adverse limb events. At the assumed DAPT probability for major bleeding, a decrease in probability of major bleeding in SAPT patients never outweighs the positive effect of any decrease of major adverse cardiovascular events and major adverse limb events for DAPT patients. DAPT could reduce health care costs and increase quality of life in patients with PAD.