Jneid and colleagues1 have comprehensively reviewed the clinical benefits of adding clopidogrel to aspirin therapy for patients with acute non–ST-segment elevation coronary syndromes. However, their approach was flawed in terms of focusing on relative risk reductions, a ploy commonly used by the pharmaceutical industry to promote the efficacy of their products in a misleading manner.
Given that health resources are finite, it is almost irresponsible to publish a review of the efficacy of any form of drug therapy without any discussion of the relative cost-effectiveness of the individual agents. Minimally important clinical differences can only be understood in the context of the cost paid for the benefit derived.2 In this particular case, the authors should have addressed the issue of whether it is cost-effective to routinely add clopidogrel to aspirin therapy in patients with acute coronary syndromes. This, of course, is where the pharmaceutical industry, with their array of newer antiplatelet agents, will find it difficult to justify their use in practice, other than in patients who have contraindications to aspirin and perhaps those who are intolerant of aspirin therapy, or in whom aspirin therapy alone has failed.