Economic evaluation of ticagrelor for secondary prevention following acute coronary syndromes

Area of Science:

• Pharmacoeconomics
• Cardiovascular Medicine
• Health Technology Assessment

Background:

• Acute coronary syndromes (ACS) represent a significant burden on healthcare systems.
• Effective antiplatelet therapy is crucial in managing ACS patients post-event or intervention.
• Ticagrelor has demonstrated clinical benefits in ACS, but its economic value requires evaluation.

Purpose of the Study:

• To assess the cost-effectiveness and cost-utility of ticagrelor compared to clopidogrel in ACS patients.
• To analyze the economic impact across various ACS treatment strategies (medical, PCI, CABG).
• To determine the incremental cost per life year (LY) and quality-adjusted life year (QALY) gained with ticagrelor.

Main Methods:

• A hybrid model combining a decision tree and a Markov model simulated patient outcomes.
• Clinical data were sourced from the landmark PLATO trial.
• Resource utilization data were gathered from hospital databases, legislation, and literature.

Main Results:

• Ticagrelor use resulted in an average gain of 0.1276 life years and 0.1106 QALYs per patient.
• The societal perspective showed an additional expenditure of €610 per patient.
• The incremental cost per LY saved was €4780, and per QALY gained was €5517.

Conclusions:

• Ticagrelor demonstrated superior event reduction compared to clopidogrel in ACS.
• The economic gains from prevented events partially offset the higher acquisition costs of ticagrelor.
• Ticagrelor is considered cost-effective in clinical practice for ACS management compared to generic clopidogrel.