Clopidogrel used in combination with aspirin compared with aspirin alone in the treatment of non-ST-segment-elevation acute coronary syndromes: a systematic review and economic evaluation


Aspirin is the most commonly prescribed antiplatelet agent, which is known to reduce the risk of fatal and non-fatal myocardial infarction in patients with unstable angina. Clopidogrel, a different antiplatelet agent, inhibits platelet aggregation induced by adenosine diphosphate, thereby reducing ischaemic events. Combining clopidogrel with aspirin may therefore have an additive effect as each acts via a different inhibitory pathway. This systematic review assessed the clinical effectiveness and the cost-effectiveness of clopidogrel used in combination with standard therapy including aspirin, compared with standard therapy alone for the treatment of non-ST-segment elevation acute coronary syndromes (ACS).


The results of the CURE trial indicate that clopidogrel in combination with aspirin was significantly more effective than placebo combined with aspirin in a wide range of patients with ACS. This benefit was largely related to a reduction in Q-wave myocardial infarction. There was no statistically significant benefit in relation to mortality.

The results from the base-case model suggest that treatment with clopidogrel as an adjunct to standard therapy (including aspirin) for 12 months, compared with standard therapy alone, is cost-effective in non-ST elevation ACS patients as long as the health service is willing to pay £6078 per additional QALY. However, although treatment with clopidogrel for 12 months remained cost-effective for the overall cohort, provisional findings indicate that the shorter treatment durations may be more cost-effective in patients at low risk.

Conducted by: C Main1, S Palmer2, S Griffin2, L Jones1, V Orton1, M Sculpher2, R Henderson3, C Sudlow4, N Hawkins2, R Riemsma1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics; 3. Nottingham City Hospital; 4. University of Edinburgh

Further details

Project page on HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal 80: Clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome. London: National Institute for Clinical Excellence; 2004


Main C, Palmer S, Griffin S, Jones L, Orton V, Sculpher M, Henderson R, Sudlow C, Hawkins N, Riemsma R. Clopidogrel used in combination with aspirin alone in the treatment of non ST segment elevation acute coronary syndromes: a systematic review and economic evaluation. Health Technol Assess. 2004;8(40):1-176


Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process