Long-term cost-effectiveness of clopidogrel in stemi patients

Long-term cost-effectiveness of clopidogrel in stemi patients Long-term administration of clopidogrel after PCI was associated with a lower rate of cardiovascular death, MI, or any revascularisation (p=0.03) and with 31% reduction cardiovascular death or MI (p=0.002).. and long-term cost-effectiveness analysis found fondaparinux. trial that randomly assigned 1917 STEMI patients undergoing emergency. Introduction. Current guidelines recommend 12 months of clopidogrel treatment following acute myocardial infarction (MI) for patients treated with and without the use of percutaneous coronary intervention (PCI) on the basis of randomized trials. 1-4 It has been debated whether treatment with clopidogrel should be extended beyond 12 months after an MI and some have even speculated on the. 5.60.040 Section: Prescription Drugs Effective Date: April 1, 2023 Subsection: Central Nervous System Drugs Original Policy Date: October 11, 2019 Subject: Abilify Mycite Page: 3 of 5 Abilify Mycite may be considered investigational in patients less than 18 years of age and for all other indications. Prior-Approval Requirements Age 18 years of age or older Current European and American guidelines commend ticagrelor over clopidogrel for treatment of patients with acute coronary syndrome (ACS). 1, 2 These guidelines are based on the PLATO (Study of Platelet Inhibition and Patient Outcomes) trial which demonstrated that ticagrelor improved the composite end point of vascular death, non‐fatal … ASIMTUFII 960 mg and 9% for patients treated with Abilify Maintena 400 mg. In both treatment groups, the majority of the injection site pain events coincided with the first injection of ABILIFY ASIMTUFII 960 mg (21/24 patients) or Abilify Maintena 400 mg (7/12 patients), was reported with decreasing frequency upon subsequent injections. Cost-effectiveness analysis (CEA) always involves comparison of a new therapy to a previous standard or control.13Effectiveness is most commonly measured in life years or quality adjusted life years, which permits comparison of CEA across wide disciplines in medicine. Long-Acting Typical Antipsychotics; Flupentixol decanoate (Fluanxol Depot) 20 mg/1 mL: vial for injection: 7.4016: 20 mg to 40 mg IM every 2 to 3 weeks: 0.35 to 1.06: 128 to 386: 100 mg/1 mL: 37.0079: Fluphenazine decanoate (Modecate) 100 mg/1 mL: vial for injection: 29.7800: 12.5 mg to 50 mg IM every 2 to 3 weeks: 1.42 to 2.13: 518 to 776. The Global Abilify Maintena market is anticipated to rise at a considerable rate during the forecast period, between 2022 and 2030. In 2021, the market is growing at a steady rate and with the. After two years of follow-up, chronic maintenance therapy with clopidogrel resulted in a 30% reduction in deaths, heart attacks, strokes or major bleeding events, according to research presented at the American College of Cardiology's 70 th Annual Scientific Session. For patients undergoing primary PCI and in patients undergoing PCI more than 24 hours of receiving fibrinolytic therap y: - In patients ≥ 75 years old the 600 mg LD should be administered with caution (see section 4.4). • Paediatric population Clopidogrel should not be used in children because of efficacy concerns (see section 5.1). .99 .99 / Yard Add to Cart Item #: 432199 Designer: Mood Designer Fabrics Mood Exclusive Monstera Mambo Cotton and Viscose Striped Seersucker Usually ships within 1 business day .99 .99 / Yard Add to Cart Item #: 432457 Designer: Mood Designer Fabrics Mood Exclusive Paisley Pantomime Cotton Poplin Usually ships within 1 business day Results: Treatment with clopidogrel was associated with the lowest effectiveness (7.41 QALYs, 95% confidence interval [CI] 1.05-14.79) and the lowest cost ($39 601, 95% CI $8434-$111 186). Ticagrelor treatment had an effectiveness of 7.50 QALYs (95% CI 1.13-14.84) at a cost of $40 649 (95% CI $9327-$111 881). The CHARISMA (Clopidogrel for High Atherothrombotic Risk, Ischemic Stabilization, Management, and Avoidance) study group suggested that long-term DAPT with aspirin and clopidogrel is... In Germany, clopidogrel treatment had an incremental cost-effectiveness ratio (ICER) of euro 92/LYG. Data from the COMMIT study showed that clopidogrel treatment resulted in 0.194 LYG at an incremental cost of euro 538 in Sweden, euro 798 in Germany, and euro 545 in France. Over a lifetime, treating for 1 year with clopidogrel-plus-aspirin produced a gain of 0.1187 life years at an incremental cost of $1269 compared to aspirin alone, resulting in an incremental cost. The purpose of the present study is to evaluate the longterm cost-effectiveness of clopidogrel in patients with STEMI, by translating the reduction in primary fatal and non-fatal events observed with clopidogrel in both the COMMIT and the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trials into estimates of gains in life exp... Although comparable 30-day and 1-year safety was shown with clopidogrel or ticagrelor in the TREAT study, there is paucity of long-term outcomes in pharmacoinvasive treated STEMI. Methods We conducted an observational cohort study evaluating consecutive pharmacoinvasive STEMI patients treated in a network, comparing those switched to ticagrelor. Slow Cooker Carnitas and Rice: This meal is one of the cheapest I have ever prepared, at just per serving. It's also incredibly flavorful, and is packed with good calories and carbohydrates (from the tomatoes, rice and beans). This is one of our favorite crockpot meal prep ideas! Percutaneous coronary intervention (PCI). For people with ACS who are undergoing PCI, aspirin (75-100 mg) in combination with one of the following antiplatelets is initiated in secondary care: Prasugrel 10 mg daily (or 5 mg daily if the person weighs less than 60 kg, or if the person is 75 years of age or older). Objectives: We sought to evaluate the long-term cost-effectiveness of clopidogrel for up to one year after an acute coronary syndrome (ACS) without ST-segment elevation.Background:. Long-term cost-effectiveness of clopidogrel in STEMI patients International Journal of Cardiology, 135 (3): 353. Plavix (clopidogrel) and low-dose aspirin are commonly taken after a heart attack to prevent another one from occurring. Depending on what you're taking Plavix and aspirin for, the duration of treatment may vary. Some people take these medications for up to 12 months after a heart attack or stent placement, and even longer in some cases. Over a lifetime, treating for 1 year with clopidogrel-plus-aspirin produced a gain of 0.1187 life years at an incremental cost of $1269 compared to aspirin alone, resulting in an incremental cost-effectiveness ratio (ICER) of $10,691/life year gained. Among patients age <75 years with STEMI, administration of ticagrelor after fibrinolytic therapy did not significantly reduce the frequency of cardiovascular events when compared with clopidogrel. (Ticagrelor in Patients With ST Elevation Myocardial Infarction Treated With Pharmacological Thrombo … The findings of a new study suggest that continuing use of blood thinners, such as Plavix or Effient, for more than 30 months after placement of a stent may decrease the risk of heart attacks and... Some inhibition of platelet clotting is seen within two hours of taking the drug; however, it takes between three to seven days of regular Plavix dosing to reach its maximal effect. Bleeding time and platelet aggregation return to baseline values within 5 days of treatment discontinuation. In the CLARITY - TIMI 28 trial, clopidogrel taken with aspirin and other standard therapy including thrombolytics significantly reduced the odds of STEMI patients having another occluded artery, or a second heart attack or death by 36 percent by day eight of hospitalization or discharge (event rate: 15.0% in clopidogrel arm vs. 21.7% in placebo. Abilify Asimtufii FDA Approval History. Last updated by Judith Stewart, BPharm on May 1, 2023.. FDA Approved: Yes (First approved April 27, 2023) Brand name: Abilify Asimtufii Generic name: aripiprazole Dosage form: Extended-Release Injectable Suspension Company: Otsuka Pharmaceutical Co., Ltd Treatment for: Schizophrenia, Bipolar Disorder Abilify Asimtufii (aripiprazole) is a long-acting. Guidelines recommend that DAPT should be maintained for at least 12 months. 11 However, shorter durations (eg, 6 months) may be considered in patients at increased risk of bleeding. Prolonging DAPT beyond 12 months may further reduce the risk of ischemic events, albeit at the expense of increased bleeding. To assess the long-term cost effectiveness of treatment for 1 month, and for 1 year with clopidogrel in addition to standard therapy (including aspirin) compared with standard therapy alone,... Cost-effectiveness of ticagrelor versus clopidogrel. cohort (B150 mg) for all ACS patients and subtypes NSTEMI/IA and STEMI. A decision-tree approach was. Long-term impact Germany

Only one antiplatelet drug is recommended if the patient also needs long-term anticoagulation.. Tognoni G, Fox KK, et al; Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001;345:. The probability that clopidogrel remains cost effective within the generally accepted pounds 30,000 per QALY threshold is more than 80%. The confidence interval around the relative risk for... However, hospital costs were lower with clopidogrel than with standard therapy because of fewer medical complications and the need for fewer cardiovascular procedures with clopidogrel, which helped offset the acquisition cost of clopidogrel.[23-28] 4.2 Long-term Cost-Effectiveness Analyses Using Within-Trial Data Number of patients included Long-term clopidogrel plus aspirin Short term clopidogrel plus aspirin or aspirin alone; Overall incidence of death: 56,799: 6.7%: 6.6%: Incidence of cancer adverse. OBJECTIVE. This study was designed to assess the cost-effectiveness of clopidogrel in short- and long-term treatment of ST-segment elevation myocardial infarction (STEMI) with the use of data from 2 trials in Sweden, Germany, and France: CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) and COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial). Patients who received fibrinolytic therapy for STEMI were randomized to delayed ticagrelor (n = 1,913) versus clopidogrel (n = 1,886). Patients were randomized a median of 11 hours after fibrinolysis and 90% had been pretreated with clopidogrel. Total number of enrollees: 3,799; Duration of follow-up: 30 days ; Mean patient age: 58 years May 17, 2012 May 16, 2012 (Hamilton, Ontario)— For years it was the second-best selling drug in the world, with more than $9 billion in global sales in 2010 alone, but the golden era of a patented... One-year treatment with ticagrelor is associated with an estimated 0.1796 life-years gained (LYG) and gained 0.1570 quality-adjusted life-years (QALY), respectively, over the lifetime horizon. Overall average cost with ticagrelor is estimated to be EUR 11,815 vs. EUR 11,387 with generic clopidogrel over a lifetime horizon. Evaluating the long‐term cost‐effectiveness of clopidogrel on top of standard therapy in patients with acute coronary syndromes without ST‐segment elevation in Sweden found it to be safe and effective. Objectives. The purpose of this study was to evaluate the long‐term cost‐effectiveness of clopidogrel on top of standard therapy (including ASA) in patients with acute coronary. The efficacy of Abilify Asimtufii is based on the adequate and well-controlled studies of Abilify Maintena (aripiprazole) in the treatment of schizophrenia or maintenance treatment of bipolar I disorder in adults. The aripiprazole concentrations of Abilify Asimtufii were explored in a pharmacokinetic bridging study which was a 32-week, open. complete the online Cal Grant C Supplement Form through your WebGrants for Studentsaccount by the requested deadline. Use up to ,462 for tuition and fees and 7 for books, tools, and equipment at any Cal Grant eligible private for profit or private nonprofit institution. Use up to ,094 at any California Community College. Introduction. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial evaluated the efficacy and safety of clopidogrel plus aspirin compared with aspirin alone when initiated early and continued long term (up to 12 months, average of 9 months), in patients presenting with unstable angina or a non-ST-segment elevation myocardial infarction (MI) (). Introduction. In Germany, every year more than 400,000 patients are admitted to hospitals for suspected acute coronary syndrome (ACS) [].Cardiovascular (CV) disease is the leading cause of mortality in Germany, with more than 60,000 deaths due to acute or recurrent myocardial infarction [].Despite high resource use and services supplied to these patients mortality rates of 30 % or higher have. Long-term cost-effectiveness of clopidogrel in STEMI patients. Int J Cardiol. 2009; 135:353-360. doi: 10.1016/j.ijcard.2008.04.011.. Long-term cost effectiveness of early and sustained dual oral antiplatelet therapy with clopidogrel given for up to one year after percutaneous coronary intervention results: from the Clopidogrel for the. STEMI patients with concurrent Covid-19 infection had an increased risk for in-hospital mortality compared with control STEMI patients from the pre-Covid-19 era (33% vs. 4%, P < 0.001) . As Covid-19 extends into the second year with different surge patterns worldwide, the collateral damages and clinical challenges persist for STEMI systems of care. In Germany, clopidogrel treatment had an incremental cost-effectiveness ratio (ICER) of €92/LYG. Data from the COMMIT study showed that clopidogrel treatment resulted in 0.194 LYG at an incremental cost of €538 in Sweden, €798 in Germany, and €545 in France. The corresponding ICERs were €2772/LYG, €4144/LYG, and €2786/LYG, respectively. As well as being effective and safe in patients with ACS, studies have indicated that clopidogrel is cost effective in this patient population, with an estimated cost-effectiveness ratio of approximately $3,000 per life year gained [ 64, 65 ]. According to this review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Europe PMC is an archive of life sciences journal literature. Fig. 1 shows the structure of the cohort Markov model, representing the states patients may reside in or move to following their initial STEMI. This model was used to extrapolate the long-term cost and health effects of the two treatment groups beyond the limited follow-up periods of the two pivotal trials for clopidogrel in STEMI: COMMIT (mean follow-up 14.9 (SD 7.9) days) and CLARITY (86. This study was designed to assess the cost-effectiveness of clopidogrel in short- and long-term treatment of ST-segment elevation myocardial infarction (STEMI) with the use of data from 2 trials. In the short-run, cost-effectiveness is based on efficacy data derived from the CLARITY trial. The cost-effectiveness of continued treatment is addressed by analysing which conditions need to be fulfilled to deem the strategy 'cost-effective', and discussing whether it is likely that it is. Long-term cost-effectiveness of clopidogrel in STEMI patients. @article{Zhang2009LongtermCO, title={Long-term cost-effectiveness of clopidogrel in STEMI patients.}, author={Zefeng Zhang and Paul Kolm and Frederique Mosse and Joseph D. Jackson and Liping Zhao and William S. Weintraub}, journal={International journal of cardiology}, year={2009. We sought to determine the incremental cost-effectiveness of clopidogrel therapy in this patient population. We used primary patient-level resource use and clinical outcomes data from 3491 STEMI patients treated with fibrinolysis and either clopidogrel or. Even in a sensitivity analysis accounting for higher long-term medical costs due to. The more common side effects that can occur with clopidogrel include: bleeding itchy skin If you have itchy skin, it may go away within a few days or a couple of weeks. If it is more severe or... 1. Go Los Angeles Pass (Top Pick) The Go Los Angeles Pass saves up to 47% off of admission to over 40 top Los Angeles attractions and other Southern California attractions, including Six Flags Magic Mountain, Knott's Berry Farm, Universal Studios Hollywood, and LEGOLAND California, in four simple steps:. Choose the pass option that best suits you. (You can buy an All-Inclusive pass that. Life expectancy gain as a result of the prevention of death, myocardial infarction, and stroke was estimated using Framingham data. Results: Within 28 days, adding clopidogrel to aspirin is likely a dominant strategy, lowering the event rate (9.2% vs. 10.1%) without an increase in cost ($7791 vs. $7797). Clopidogrel — give a loading dose of 600 mg, 24 hours after the last ticagrelor dose. Then continue with 75 mg daily. Prasugrel — give a 60 mg loading dose, 24 hours after the last ticagrelor dose. Then continue with 10 mg daily. Basis for recommendation How should I manage people taking antiplatelets who are undergoing surgery or dental treatment? In patients who are intolerant of ASA, clopidogrel and MRD are the only available long-term therapy options available, and only MRD may be used post ischaemic stroke events as per the TA90 guidance. 24 These are compared with the 'no-treatment' scenario in Table 63 and indicate that clopidogrel followed by MRD is the most cost-effective. It is given to patients with acute coronary syndrome (ACS), to patients who have already had a heart attack, severe chest pain, or a stroke, or to patients with other circulation problems (eg, peripheral arterial disease) that could cause a stroke or heart attack. Acute coronary syndrome is a condition where the blood flow to the heart is blocked. (2010). Cost-effectiveness of clopidogrel in STEMI patients in the Netherlands: a model based on the CLARITY trial. Current Medical Research and Opinion: Vol. 26, No. 3, pp. 641-651. We randomly assigned 12,562 patients who had presented within 24 hours after the onset of symptoms to receive clopidogrel (300 mg immediately, followed by 75 mg once daily) (6259 patients) or... Long-term cost-effectiveness of clopidogrel in STEMI patients ☆. Author links open overlay panel Zefeng Zhang a b, Paul Kolm e, Frederique Mosse c, Joseph Zefeng Zhang a b, Paul Kolm e, Frederique Mosse c, Joseph In patients with baremetal stents, clopidogrel should be continued for at least one month; it should be continued for several months in patients with drug-eluting stents (at least three... From the perspective of the US healthcare system, 1 year of ticagrelor therapy is reasonably cost-effective compared with clopidogrel in patients with ACS, according to an economic analysis of the PLATO trial published February 2, 2015, in the Journal of the American College of Cardiology. The management of a STEMI aims to restore adequate coronary blood flow as quickly as possible and to reduce mortality. Coronary reperfusion therapy (either primary PCI or fibrinolysis) should be delivered as soon as possible in eligible patients with a STEMI. Efficacy, Safety, and Cost-Effectiveness. Clopidogrel has been shown to be an efficacious, safe, and cost-effective way of reducing cardiovascular and total mortality in patients with acute coronary syndrome and in patients after percutaneous coronary interventions. 36 - 39 In the prespecified STEMI subgroup analysis of a 2012 systematic. Making safe and wise decisions for biological disease-modifying antirheumatic drugs (bDMARDs) and other specialised medicines. Improving clinical practice and health outcomes for Australia. Provides health professionals with timely, independent and evidence-based information Opens a new window Introduction: ST-elevation myocardial infarction (STEMI) occurs as a result of plaque rupture, leading to interruption of arterial blood flow and subsequent myocardial necrosis. The incidence of hospital admission relating to STEMI in the UK is around 5 per 1000 people each year. A one-year decision tree model combined with a 20-year Markov transition model was used to stimulate long-term cost and effectiveness of both ticagrelor and clopidogrel in Iran based on an Iranian payer perspective. The clinical efficacy data were extracted from PLATO trial and other published studies. The primary endpoints are the combined outcomes of death, non-fatal myocardial infarction and stroke at 12 months. Results Overall 949 (33.7%) patients had CKD and 2660 (94.36%) patients received clopidogrel treatment. 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The apartments have spectacular views and are fully equipped. .08/Count) .85 with Subscribe & Save discount All patients undergoing PCI should receive a 600 mg loading dose of clopidogrel, followed by 75 mg/day for 12 months. In patients treated with clopidogrel in whom coronary artery bypass grafting is planned, the procedure should be delayed for 5 days, if possible, to reduce the risk of bleeding. Additionally, regional STEMI systems of care have provided essential insights into STEMI care through the use of detailed prospective registries, which have the advantages of: (1) including all STEMI patients without exclusion criteria; (2) providing a detailed database for high-risk STEMI patients such as CS or OHCA; (3) presenting detailed … Clopidogrel (like ticlopidine) is a prodrug, which needs to be metabolized by the liver to an active metabolite with antiaggregating activity ( Figure 1 ). 25 Therefore, its pharmacological effect can be detected only some time after its first administration and, more importantly, the plasma levels of the active metabolite vary widely among subj... Addition of clopidogrel to aspirin, given up to 1 year, in the setting of STEMI is a highly cost-effective strategy. No full-text available. Although DES have been shown to decrease... FDA News FOR IMMEDIATE RELEASE P06-115 August 17, 2006 Media Inquiries: Laura Alvey, 301-827-6242 Consumer Inquiries: 888-INFO-FDA FDA Approves New Medical Use for Plavix Overall, the critical components of optimized regional STEMI systems of care are well-established standardized STEMI protocols, which should include: (1) predetermined STEMI diagnosis criteria; (2) activation of the system with a single phone call; (3) pre-identified transport plans to PCI centers; and (4) administration of the … Background— Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is superior to fibrinolysis when performed in a timely manner in high-volume centers. Recent European trials suggest that transfer for PCI also may be. Background— Percutaneous coronary intervention (PCI) for ST-elevation myocardial. The aim of this study was to assess the long-term cost-effectiveness of treating ACS patients for 12 months with ticagrelor compared with generic clopidogrel. Methods and results Event rates, health-care costs, and health-related quality of life during 12 months of therapy with either ticagrelor or generic clopidogrel were estimated from PLATO. 1. INTRODUCTION. Dual antiplatelet therapy (DAPT), that is combining aspirin and a P2Y 12 inhibitor (ticagrelor or clopidogrel), is the key treatment for patients with acute coronary syndrome (ACS). In the patients with ST‐segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), DAPT is recommended for up to 12 months. 1, 2 Despite the. The results indicate that long-term (12 months or longer) dual antiplatelet therapy with clopidogrel and aspirin do not appear to change the overall risk of death when compared to short-term... Long-term cost-effectiveness of clopidogrel in STEMI patients - ScienceDirect International Journal of Cardiology Volume 135, Issue 3, 10 July 2009, Pages 353-360 Long-term cost-effectiveness of clopidogrel in STEMI patients☆ Zefeng Zhang a b , Paul Kolm e , Frederique Mosse c , Joseph Jackson d , Liping Zhao b , William S. Weintraub e Even in a sensitivity analysis accounting for higher long-term medical costs due to greater life expectancy, clopidogrel remained under $6000 per LYG. Clopidogrel therapy was dominant in 35% of the bootstrap simulations and cost less than $50,000 per LYG in 67% of simulations. Treatment of these STEMI patients with clopidogrel appeared to be cost-effective in all 3 European countries studied. Predicted ICERs were below generally accepted threshold values.. The long-term cost-effectiveness of clopidogrel plus aspirin in patients undergoing percutaneous coronary intervention in Sweden. Clin Ther, 27 (2005), pp. 100-110. The COMMIT trial demonstrated that clopidogrel produced a 9% relative reduction in death, reinfarction or stroke (9.2% vs. 10.1%, 95% CI: 0.86-0.97) in ST-elevated myocardial infarction (STEMI) patients. For all stents, the recommended duration of DAPT (aspirin and clopidogrel) is 6 months and aspirin continued thereafter for life. The COMPASS trial 30 demonstrated the value of low ('vascular') dose rivaroxaban (2.5 mg two times a day) in combination with aspirin. However, this trial was not linked to myocardial revascularisation procedures. Long-Term Clopidogrel Is Cost Effective The long-term use of the platelet inhibitor clopidogrel in patients with acute coronary syndromes is cost effective as well as clinically effective, reported William S. Weintraub, M.D., of Emory University, Atlanta, and his associates. Eight patients with APS (42.1%) received clopidogrel before the PCI (mostly because of history of stroke), and they all continued to receive long-term clopidogrel treatment after the procedure. The other patients in the group generally received clopidogrel for 3-12 months after the PCI, depending on the presentation (ACS or stable angina) and. The cost of clopidogrel was based on the year 2003 with cardiovascular disease (12.3 years for men and average wholesale price of $4.22 a day. 16.1 years for women); for myocardial infarction, LYL was derived by using life expectancy of cardiovascular disease 2.4. The cost effectiveness analysis of CURE-PCI, published in 2006, showed that clopidogrel was associated with a higher average cost at 1 year of $253 - $423. For patients who underwent PCI during the initial hospitalization, the difference was less substantial and ranged from $155 lower to $90 higher with clopidogrel. Overall, the critical components of optimized regional STEMI systems of care are well-established standardized STEMI protocols, which should include: (1) predetermined STEMI diagnosis criteria; (2) activation of the system with a single phone call; (3) pre-identified transport plans to PCI centers; and (4) administration of the guideline-recomme... Our competitive rates help you ship to any address in Canada. Benefits Save up to 48% compared to national carriers Full tracking 2-8 business days delivery* Ship to any address in Canada Chit Chats Insurance Prices are in CAD and do not include GST or insurance. Rates subject to change due to variations in fuel surcharges and other factors.

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