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Clopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost- effectiveness analysis Mark D. Schleinitz, MS, MD, J.Peter Weiss, MS, MD, Douglas K. Owens, MS, MD The American Journal of Medicine Volume 116, Issue 12, Pages (June 2004) DOI: /j.amjmed
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Figure 1 Schematic representation of the decision model. The square node on the left depicts the treatment decision. The Markov states are outlined. In each monthly cycle, patients face the risk of one or several vascular events (myocardial infarction, stroke, amputation, or vascular death), one or several hemorrhagic events (gastrointestinal bleeding or intracranial hemorrhage), or another side effect (thrombotic thrombocytopenic purpura). At the completion of each cycle, patients return to the Markov state appropriate for both the Markov state in which they began the cycle and the events occurring during the cycle. Triangles depict transition to the “dead” Markov state. Not shown is the risk of age-related mortality, which is present in each cycle. The American Journal of Medicine , DOI: ( /j.amjmed )
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Figure 2 One-way sensitivity analysis for patients with peripheral arterial disease. Bars depict the effect of varying the indicated parameter through the specified range on the cost-effectiveness ratio of clopidogrel relative to aspirin. The values for each parameter are shown in parentheses. Variation in the efficacy of clopidogrel in both the stroke and myocardial infarction models resulted in cost-effectiveness ratios approaching both negative and positive infinity. QALY = quality-adjusted life-year; RRR = relative risk reduction. The American Journal of Medicine , DOI: ( /j.amjmed )
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Figure 3 Results of probabilistic sensitivity analysis. Cost-effectiveness acceptability curves are shown for each subgroup, each the result of a 1000-simulation Monte Carlo analysis. The horizontal axis depicts potential cost-effectiveness thresholds, while the vertical axis depicts the proportion of simulations for which clopidogrel resulted in a greater net monetary benefit than did aspirin at the indicated threshold. QALY = quality-adjusted life-year. The American Journal of Medicine , DOI: ( /j.amjmed )
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