COMMENTS AND RESPONSES Cost-Effectiveness of Clopidogrel plus Aspirin versus Aspirin Alone

their finding that combination antiplatelet therapy with clopidogrel and aspirin in the first year following an acute coronary syndrome “represents good value according to traditional limits of cost-effec-tiveness ” has serious economic implications if adopted into practice. Although decision analytic models offer valuable insight into treat-ment decisions, such as the observation that the first month of treat-ment is much more cost-effective than subsequent months, the sim-plifying assumptions required for modeling can lead to biased conclusions when comparing the cost-effectiveness of an intervention with an external benchmark. Before making treatment or policy de-cisions on the basis of a decision model, it is important to examine the key assumptions. In this analysis, the authors apply the 20% reduction in overall vascular events seen in the Clopidogrel in Un-stable Angina to Prevent Recurrent Events (CURE) trial (2) equally to nonfatal myocardial infarctions, strokes, and death from cardio