OBJECTIVES: Clopidogrel or aspirin is indicated for patients at risk of ischaemic events. By using the latest prices of clopidogrel and aspirin, we compared the cost-effectiveness of clopidogrel with that of aspirin in Chinese patients with recent ischemic stroke (IS), myocardial infarctions (MI) and established peripheral artery disease (PAD).

METHODS: A discrete-event simulation was developed to evaluate the economic implications of secondary prevention with clopidogrel versus aspirin. All available evidence was derived from clinical studies. Costs from a Chinese health care perspective in 2020 US dollars and quality-adjusted life years (QALYs) were projected over patients’ lifetimes. Uncertainties were addressed using sensitivity analyses.

RESULTS: Compared with aspirin, clopidogrel yielded marginally increased life expectancy by 0.22, 0.10 and 0.28 QALYs with the saved costs of $262, $745 and $1,938 in patients with recent IS, MI and established PAD, respectively. One-way sensitivity analyses showed that the model output were robust except the parameter of patient age. Given a willingness to pay threshold of $11,145 per QALY gained (per Capita GDP of China in 2020), clopidogrel had probabilities of >95% of being cost-effective in the recent IS, MI and established PAD subgroups compared with aspirin, respectively.

CONCLUSIONS: The analysis suggests that clopidogrel for secondary prevention is cost-saving for patients at risk of ischaemic events in a Chinese setting in comparison with aspirin.