Buskens, E

Heeg, BMS

van Hout, BA

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642 Abstracts
OBJECTIVES: The purpose of this study was to estimate the
preferences of postmenopausal women for disease states associ-
ated with EBC. METHODS: Preferences for relevant health
states and demographic information were obtained from women
aged 55–70 years in the UK and the USA with a history of stage
one or two operable EBC and experience with adjuvant hor-
monal therapy. The 14 health states included in the study, which
were compiled from literature and input from oncologists,
reﬂected the major disease states of breast cancer and the adverse
events reported in the ATAC trial (Cancer 2003; 98:1802–10).
A chained standard gamble (SG) technique was used to compare
health states to perfect and worst health (WH) and then WH
against perfect health and death. WH values were used to rescale
values (0 = death, 1 = perfect health). Pooled and country-
speciﬁc utilities were analysed and compared. RESULTS: A total
of 67 subjects (UK = 23, USA = 44) successfully completed the
SG interviews. There were few differences between country
samples. For the pooled sample, mean age was 67.8 years, 49%
were retired, 61% were living with someone, and 51% had
arthritis. More US than UK women had received radiotherapy
and/or chemotherapy. Raw WH values differed signiﬁcantly
between country samples (UK = 0.844, USA = 0.455; p < 0.001).
Adjusted mean SG scores were 0.432–0.974 for the pooled
sample, 0.710–0.989 for the UK sample, and 0.288–0.965 for
the US sample. Mean current health values for the pooled, UK
and US samples were 0.907, 0.933 and 0.893, respectively.
CONCLUSIONS: The order of adjusted and unadjusted SG
scores within each country was consistent, with the metastatic
breast cancer and disease-free survival with no adverse events
health states being the least and most preferred, respectively.
When comparing utilities across countries, care must be taken in
cases of signiﬁcantly different WH values.
Session II
CARDIOVASCULAR II
CV5
THE COSTS AND EFFECTS OF CLOPIDOGREL IN 
COMPARISON TO ASA OR PLACEBO FOR SEVERAL 
PATIENT POPULATIONS IN DENMARK
Heeg BMS1, Buskens E1, Hout van BA1
1PharMerit BV,The Netherlands
BACKGROUND: CAPRIE was an international randomized
double blind trial comparing clopidogrel and ASA in patients
with recent MI, stroke or PAD. Post-hoc analyses of the CAPRIE
database identiﬁed three high-risk subgroups in which improved
risk reductions were observed of clopidogrel compared to ASA.
OBJECTIVE: To estimate the long and short term costs and
effects of clopidogrel versus ASA in Denmark in the prevention
of ischemic events (MI, IS, VD) in three high-risk CAPRIE sub-
populations: 1) patients with a history of coronary artery bypass
grafting; 2) patients with a history of ischemic events; 3) patients
with multiple vascular territory involvement. In addition to this,
an analysis for ASA intolerant patients in the general CAPRIE
population was performed. METHODOLOGY: A Markov
model consisting of 24 health states that combined clinical, epi-
demiological and cost data was used to assess the cost and effects
of clopidogrel in comparison to ASA. Only in the ASA intoler-
ant patients, clopidogrel was compared to no treatment.
RESULTS: The comparison of clopidogrel with ASA in the high-
risk CAPRIE sub-groups resulted in cost-effectiveness ratios of
DKK 25,445 (€ 3424) /LYG, DKK 51,198 (€ 6881)/LYG, and
DKK 55,503 (€7460)/LYG for 1) patients with a history of coro-
nary artery bypass grafting; 2) patients with a history of ischemic
events, and 3) patients with multiple vascular territory involve-
ment respectively. The comparison of clopidogrel to no treatment
for the ASA intolerant patients resulted in DKK 3093
(€416)/LYG. Cost-effectiveness ratios of this order are generally
considered acceptable in modern Western societies. Internal and
external validity have been tested and were ascertained. CON-
CLUSION: Clopidogrel may be considered a cost-effective treat-
ment for the prevention of subsequent ischemic events in
high-risk patient populations and in the general CAPRIE-popu-
lation with ASA intolerance in Denmark. Extensive sensitivity
analyses conﬁrmed that these results were stable over the entire
range of assumptions.
CV6
WHAT IS THE ADDED VALUE OF HEALTH RELATED QUALITY
OF LIFE (HRQL) DATA? AN EXAMPLE FROM THE
INTERNATIONAL SUBARACHNOID ANEURYSM TRIAL (ISAT)
Lloyd A1, Scott R2, Carpenter K2
1MEDTAP International, London, UK; 2Oxford University, Oxford, UK
OBJECTIVES: The International Subarachnoid Aneurysm Trial
(ISAT) has revealed signiﬁcantly better clinical outcomes for
patients randomised to endovascular treatment as measured
using the modiﬁed Rankin scale (mRS). ISAT compared the pro-
portion of patients with a mRS grade of three or over (indicates
higher level of impairment and dependency) following endovas-
cular or neurosurgical treatment. The HRQL data were explored
to determine whether there are differences in patients ranked 0–2
on the mRS as well as three or over. METHOD: A sub-sample
of ISAT patients from 8 UK centres completed a thorough assess-
ment of HRQL (SF-36 and Functional Limitations Proﬁle) and
cognitive function at 12 months following treatment. HRQL
data are reported here. Differences were tested using one-way
ANOVA with post-hoc comparisons (LSD) between mRS grades.
RESULTS: Every domain of the SF-36 declines signiﬁcantly with
deteriorating mRS grade. The post-hoc comparisons reveal that
each grade is signiﬁcantly worse than the next lower grade, apart
from grades four and ﬁve. Patients within the 0–2mRS range still
report substantial declines in HRQL (PF is 90.1 at grade zero (n
= 137), to 66.6 at grade 2 (n = 144); VT is 71.6 at grade zero
and 39.9 at grade two; BP is 93.7 at grade zero and 64.0 at grade
2). Sample sizes for grades 3 and over are small, but the data
indicate that little sensitivity to differences in HRQL outcomes
in patients at these higher mRS grades. CONCLUSIONS: The
HRQL data greatly elucidates the differences in health status for
patients at different mRS grades. The HRQL data demonstrate
that simply categorising patients using a single cut-off score on
the mRS is a very crude way of measuring outcomes. Most of
the decline in HRQL scores occurs in the 0–2 range.
CV7
MODELLING SURVIVAL AND COSTS IN SWITZERLAND OF
NESIRITIDE VERSUS INOTROPIC THERAPY FOR ACUTE
DECOMPENSATED HEART FAILURE
Slivinskas J1, Levy AR1, Sendi P2, Brunner-La Rocca HP2,
Gagnon YM1, Briggs A1
1Occam Outcomes Ltd,Vancouver, BC, Canada; 2University Hospital,
Basel, Switzerland
OBJECTIVES: To estimate survival and costs of nesiritide versus
dobutamine or milrinone in patients admitted for acute decom-
pensated heart failure (ADHF) using Swiss University hospital
costs. METHODS: We constructed a decision analytic model of
hospitalisation for ADHF. Subjects started in a hospitalisation
state. Survivors at discharge could be re-hospitalised or die based
on a 6-month Markov process with monthly cycles. Data on sur-
vival and length of stay (LOS) in intensive care or general ward
were tabulated for 9239 patients admitted for heart failure to


CV5 THE COSTS AND EFFECTS OF CLOPIDOGREL IN COMPARISON TO ASA OR PLACEBO FOR SEVERAL PATIENT POPULATIONS IN DENMARK 

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CV5 THE COSTS AND EFFECTS OF CLOPIDOGREL IN COMPARISON TO ASA OR PLACEBO FOR SEVERAL PATIENT POPULATIONS IN DENMARK

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