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Editor's Correspondence
November 10, 2003

Cost-effectiveness of Newer Antiplatelet Drugs—Reply

Arch Intern Med. 2003;163(20):2533-2534. doi:10.1001/archinte.163.20.2533-a

In reply

We thank Peterson and Jackson for their interest in our article.1 However, they are mistaken on several points. We agree that absolute risk reduction is an important measure of efficacy, which is why we listed actual event rates, from which absolute risk reductions are apparent. Relative risk reduction is also important, since it allows assessment of the potential efficacy in patients with different levels of baseline risk and higher or lower event rates than the population under study—absolute risk reduction does not.2 Thus, for the physician taking care of patients, both measures of efficacy are relevant. Indeed, in the CURE study there was a 2.1% absolute risk reduction in hard end points (cardiovascular death, myocardial infarction, and stroke) over an average treatment period of 9 months.3 This degree of absolute event reduction compares favorably with trials of statins and angiotensin-converting enzyme inhibitors for secondary prevention of ischemic events, though the event reductions noted in trials of those agents typically took several years to accrue. Thus, the benefit evident in the CURE study is likely an underestimate of the event reduction that may have been achieved with a longer duration of therapy.

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