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Updated: Dec 31, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Cost-effectiveness of Platelet Function-Guided Strategy with Clopidogrel or Ticagrelor
Nikita Lomakin1, Anna Rudakova1, Liudmila Buryachkovskaya2
1Cardiology Division, Central Clinical Hospital, Presidential Affairs Department Moscow, Russia.
Insights
Testing platelet reactivity guides dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS), reducing costs and improving outcomes. This approach is more cost-effective than routine use of expensive antiplatelet agents.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Clinical Chemistry
Background:
- Patients with acute coronary syndrome (ACS) on dual antiplatelet therapy (DAPT) may have heightened residual platelet reactivity (HRPR).
- HRPR is associated with adverse vascular outcomes, necessitating optimized DAPT strategies.
Purpose of the Study:
- To evaluate the cost-effectiveness of guided DAPT using VerifyNow P2Y12 testing.
- To compare guided DAPT with clopidogrel or ticagrelor versus standard DAPT in post-ACS patients.
Main Methods:
- Cost analysis performed per 1,000 patients aged >55 years.
- Patients received generic clopidogrel or ticagrelor for 1 year.
- VerifyNow P2Y12 assay testing was used to guide DAPT maintenance.
Main Results:
- Guided DAPT prevented 5 MIs and 6 deaths per 1,000 patients compared to standard generic clopidogrel.
- A guided strategy reduced total costs by 32% compared to routine ticagrelor administration.
Conclusions:
- P2Y12 assay testing for HRPR in post-ACS patients is a cost-effective DAPT triage strategy.
- This approach reduces financial burden compared to routine use of expensive antiplatelet agents.
Abstract:
Some patients treated with dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) can still exhibit heightened residual platelet reactivity (HRPR), which is potentially linked to adverse vascular outcomes. Better tailored DAPT strategies are needed to address this medical need.
Aim:
To assess the cost-effectiveness of guided DAPT with clopidogrel or ticagrelor in addition to aspirin when using VerifyNow P2Y12 testing in post-ACS patients.
Methods:
The costs were calculated per 1,000 patients aged >55 years. It was assumed that all patients received either generic clopidogrel or ticagrelor for 1 year, and underwent VerifyNow P2Y12 assay testing before DAPT maintenance.
Results:
Guided DAPT will prevent five more MIs and six more deaths per 1,000 patients than a standard prescription of generic clopidogrel. The total predictive value of costs per patient is 32% lower if a guided strategy is used than if ticagrelor is given to all patients.
Conclusion:
Assessment of heightened residual platelet reactivity with P2Y12 assay in triaging DAPT post-ACS patients for 1 year is a cost-effective strategy that would reduce financial burden compared to routine administration of more expensive antiplatelet agents.
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