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Updated: Jan 30, 2026
Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Ticagrelor Use in Acute Myocardial Infarction: Balancing Evidence-Based Medicine with Affordability
Andrew L Walker1, Teshia Sorensen2, Paolo P Gabriel3
1University of Utah School of Medicine, Department of Internal Medicine, Salt Lake City, USA.
Insights
High out-of-pocket costs for ticagrelor led to nearly half of acute myocardial infarction patients switching to clopidogrel after discussing medication expenses with a pharmacist.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Health Services Research
Background:
- Randomized controlled trials demonstrate a mortality benefit for ticagrelor over clopidogrel in acute myocardial infarction (AMI) patients.
- Ticagrelor is frequently the preferred treatment for AMI patients by healthcare providers.
- Patient adherence to prescribed medication can be significantly influenced by out-of-pocket expenses.
Purpose of the Study:
- To investigate the association between out-of-pocket drug costs and the decision to continue ticagrelor versus switching to clopidogrel.
- To evaluate this association among patients hospitalized for AMI after a pharmacist-led discussion on ticagrelor co-payment costs.
Main Methods:
- Retrospective cohort study conducted at a tertiary care academic medical center.
- Included patients hospitalized with AMI between February 15, 2015, and January 23, 2017, who initially received ticagrelor.
- Analyzed patient data following a pharmacist-led discussion regarding outpatient co-payment costs for ticagrelor.
Main Results:
- Of 143 AMI patients initiated on ticagrelor, 70 (49%) switched to clopidogrel post-cost discussion.
- Median monthly ticagrelor co-payment was significantly higher for switchers ($268.29) compared to non-switchers ($18) (p<0.001).
- Patients with co-payments ≥$100/month were 3.4 times more likely to switch to clopidogrel.
Conclusions:
- A pharmacist-led discussion about outpatient medication costs prompted nearly half of AMI patients to switch from ticagrelor to clopidogrel.
- High out-of-pocket costs for ticagrelor are a significant factor influencing treatment choices in AMI patients.
- Cost-saving strategies, including medication cost discussions, are crucial for maintaining patient adherence to guideline-directed therapy.
Study Objective:
Data from randomized controlled trials support a mortality benefit with ticagrelor versus clopidogrel among patients with acute myocardial infarction (AMI). Many healthcare providers preferentially treat patients with AMI with ticagrelor. The goal of this study was to determine the association between out-of-pocket drug costs and ticagrelor continuation compared with switching to clopidogrel among patients hospitalized for AMI, following a pharmacist-led discussion on outpatient co-payment costs for ticagrelor.
Design:
Retrospective cohort study.
Setting:
A tertiary care academic medical center.
Patients:
Patients hospitalized with AMI between February 15, 2015 and January 23, 2017, who were loaded with ticagrelor on presentation.
Main Results:
Of 143 patients with AMI loaded with ticagrelor, 70 (49%) switched to clopidogrel after cost discussion. The median monthly ticagrelor co-payment was $268.29 (interquartile range [IQR] $45-$350) for switchers, versus $18 (IQR $6-$24) for non-switchers (p<0.001). Patients with co-payments of $100/month or more were 3.4 times more likely to switch to clopidogrel (relative risk 3.41, 95% confidence interval 2.12 to 5.47), compared with patients with co-payments of less than $100/month.
Conclusions:
Following a discussion of outpatient costs, half of patients with AMI switched from ticagrelor to clopidogrel when given the choice.
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