Comparative resource utilization and costs for patients with acute coronary syndrome managed with percutaneous...

Area of Science:

• Cardiology
• Pharmacology
• Health Economics

Background:

• Acute coronary syndrome (ACS) management often involves percutaneous coronary intervention (PCI).
• Dual antiplatelet therapy with clopidogrel or prasugrel is standard post-PCI.
• Comparative effectiveness of these agents on clinical and economic outcomes requires ongoing evaluation.

Purpose of the Study:

• To compare in-hospital bleeding events and other outcomes between clopidogrel and prasugrel in ACS patients undergoing PCI.
• To assess the impact of these antiplatelet agents on hospital length of stay (LOS) and total hospital costs.

Main Methods:

• Retrospective analysis of a large hospital claims database.
• Inclusion of adult patients hospitalized for ACS, managed with PCI, and treated with clopidogrel or prasugrel over two years.
• Evaluation of bleeding rates, LOS, and total hospital costs using propensity score stratification for adjustment.

Main Results:

• The study included 75,297 patients on clopidogrel and 9,477 on prasugrel.
• Unadjusted bleeding rates were higher with clopidogrel (5.7%) vs. prasugrel (3.2%).
• After adjustment, no significant difference in bleeding rates was observed (OR, 0.90; p=0.0949). Prasugrel use was linked to shorter LOS (0.22 days less) and lower costs ($375 less).

Conclusions:

• Adjusted analyses revealed no significant difference in in-hospital bleeding rates between prasugrel and clopidogrel.
• Prasugrel treatment was associated with a significantly shorter mean hospital LOS and lower total mean hospital costs compared to clopidogrel.
• These findings suggest potential economic advantages of prasugrel in specific patient populations undergoing PCI for ACS.