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Cost-Consequence Analysis of Using Cangrelor in High Angiographic Risk Percutaneous Coronary Intervention Patients: A
Ivar S Jensen1, Elizabeth Wu2, Philip L Cyr2,3
1Precision Health Economics, 133 Federal Street, 10th floor, Boston, MA, 02110, USA. Ivar.Jensen@precisionvh.com.
Insights
Cangrelor use in high-risk percutaneous coronary intervention (PCI) patients may reduce ischemic events and hospital costs by avoiding delays in surgery due to oral P2Y12 inhibitor pretreatment. This approach offers improved outcomes and budget savings.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Economics
Background:
- Percutaneous coronary intervention (PCI) patients with high-risk features (HRFs) often require P2Y12 inhibitor pretreatment.
- Oral P2Y12 inhibitors necessitate a pretreatment or washout period, potentially delaying urgent cardiac surgery.
- Intravenous cangrelor offers immediate onset and rapid offset of P2Y12 inhibition, potentially mitigating these issues.
Purpose of the Study:
- To evaluate the cost implications and clinical outcomes of using cangrelor in US hospitals for PCI patients with multiple angiographic HRFs.
- To assess the potential benefits of cangrelor in avoiding oral P2Y12 inhibitor pretreatment, particularly in patients requiring subsequent cardiac surgery.
Main Methods:
- A decision analytic model was developed to estimate the 3-year annual impact of cangrelor availability.
- Ischemic and bleeding events were extrapolated from clinical trial data; costs were derived from economic substudies and literature.
- Scenario analyses explored the impact of reduced P2Y12 pretreatment rates (50-100%) with cangrelor.
Main Results:
- Increasing cangrelor use in a hospital treating 1000 PCI patients annually (from 11% to 32%) reduced ischemic events by 5.7% while slightly increasing bleeding events (2.9%).
- Total costs decreased by 12.8%, driven by reduced ischemic events, glycoprotein IIb/IIIa inhibitor use, and shorter oral P2Y12 inhibitor washout periods for surgery.
- Significant cost savings were observed with 50% or 100% reduction in P2Y12 pretreatment.
Conclusions:
- Cangrelor use in PCI patients with multiple angiographic HRFs can improve clinical outcomes.
- Implementing cangrelor may lead to lower hospital budgets primarily by avoiding surgery delays associated with oral P2Y12 inhibitor pretreatment.
Objectives:
The objective of this study was to evaluate a US hospital's cost implications and outcomes of cangrelor use in percutaneous coronary intervention (PCI) patients with two or more angiographic high-risk features (HRFs), including avoidance of oral P2Y12 inhibitor pretreatment in patients requiring cardiac surgery. Intravenous cangrelor provides direct, immediate onset and rapid-offset P2Y12 inhibition, which may reduce the necessity for oral P2Y12 pretreatment.
Methods:
A decision analytic model was developed, estimating the annual impact over 3 years of cangrelor availability. Ischemic and bleeding events (48 h) from randomized clinical trial data were extrapolated to 30 days. Event costs were from the CHAMPION PHOENIX Economics substudy. Rates of coronary artery disease (CAD) presentation, PCI, oral P2Y12 pretreatment, and inpatient hospitalization costs were from published literature and clinical experts. Scenario analyses evaluated the impact of cangrelor availability on potential reduced P2Y12 pretreatment rates by 50-100%. Drug costs were 2019 wholesale acquisition costs and, where necessary, all costs were adjusted to 2019 dollars.
Results:
In a hospital treating 1000 CAD PCI inpatients annually, increasing cangrelor use from 11 to 32% resulted in a reduction in 48-h ischemic events/year by 5.7%, while bleeding events increased by 2.9%. Total costs of $1,135,472 declined 12.8%, with a 50% reduction in P2Y12 pretreatment or 30% with no pretreatment. Savings were driven by a decrease in ischemic events, decrease in glycoprotein IIb/IIIa inhibitor use, and less need for and shorter oral P2Y12 inhibitor washout period for surgery patients.
Conclusion:
Use of cangrelor in patients with two or more angiographic HRFs may improve outcomes and lower hospital budgets, mainly from avoiding surgery delays necessitated by oral P2Y12 inhibitor pretreatment.
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