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Aspirin with Low-Dose Ticagrelor or with Low-Dose Rivaroxaban for Secondary Prevention: A Cost per Outcome Analysis

Gal Tsaban1,2, Hilmi Alnsasra3,4, Aref El Nasasra3,4

  • 1Division of Cardiology, Soroka University Medical Center, PO Box 653, 84105, Beer-Sheva, Israel. tsabang@post.bgu.ac.il.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|July 22, 2022
PubMed

Insights

Low-dose rivaroxaban combined with aspirin offers superior cost-effectiveness for preventing major adverse cardiovascular events (MACE) in high-risk patients compared to low-dose ticagrelor. This regimen provides better value for money in secondary cardiovascular prevention.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacoeconomics
  • Clinical Trial Analysis

Background:

  • Secondary prevention of cardiovascular events is crucial for patients with existing cardiovascular disease and high ischemic risk.
  • Current treatment strategies involve aspirin combined with low-dose (LD) ticagrelor or LD rivaroxaban, both superior to aspirin alone for preventing major adverse cardiovascular events (MACE).
  • The comparative economic value of LD ticagrelor versus LD rivaroxaban in this context remains unevaluated.

Purpose of the Study:

  • To compare the cost-effectiveness of LD ticagrelor plus aspirin versus LD rivaroxaban plus aspirin for secondary prevention of MACE.
  • To determine the cost needed to treat (CNT) for each regimen to prevent one MACE.

Main Methods:

  • Annual CNT was calculated by multiplying the annualized number needed to treat (aNNT) by the annual drug cost.
  • aNNTs were derived from data from the PEGASUS TIMI-54 and COMPASS trials.
  • Drug costs were based on 75% of US National Average Drug Acquisition Cost (NADAC) from January 2022.

Main Results:

  • The aNNTs to prevent MACE were 229 for LD ticagrelor and 147 for LD rivaroxaban.
  • The corresponding CNTs to prevent one MACE were US$853,254 for LD ticagrelor and US$666,351 for LD rivaroxaban.
  • LD rivaroxaban demonstrated a lower CNT, indicating better value for money.

Conclusions:

  • Combining aspirin with LD rivaroxaban offers superior value for money compared to combining aspirin with LD ticagrelor for secondary prevention of MACE.
  • This finding has significant implications for clinical practice and healthcare resource allocation in cardiovascular disease management.
Abstract

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