cost-analysis-on-ticagrelor-utilisation-in-the-treatment-of-patients-with-acute-coronary-syndrome-a-preliminary-study

Abstract

Background: Dual therapy with aspirin and clopidogrel is the standard treatment for acute coronary syndrome (ACS). Dual antiplatelet therapy plays an important role in reducing major acute, short-and long-term adverse clinical outcomes. Currently, the economic evaluation of ticagrelor, a reversible and direct-acting oral antagonist of adenosine diphosphate receptor P2Y12 remains unknown. Objective: To compare the annual cost of ticagrelor versus branded clopidogrel in patients with ACS from a Malaysian health care perspective. Methods: The data required for this analysis was obtained from a 2007 study carried out by Fong et al. in ACS patients (n=57). Assumptions used for the present analysis were based on data from the Cardiac Rehabilitation Program (CRP) study, the Study of Platelet Inhibition and Patient Outcomes (PLATO) and the National Cardiovascular Disease ACS (NCVD ACS) registry of Malaysia. For all calculations, the Ringgit Malaysia (RM) currency and prices as of 2007 were considered. Results:The cost of clopidogrel treatment in post-ACS patients for 30 days was calculated to be RM1,381,340 (n=2072; daily cost=RM5.50) and assuming treatment with ticagrelor, the cost would be RM1,554,000 (daily cost=RM8.70). Based on PLATO and NCVD ACS 2007, it was estimated that major adverse coronary event (MACE) in the form of unstable angina (UA) would occur in an additional 21 patients on clopidogrel, which could have been avoided with ticagrelor. Extrapolating cost data from CRP study, it was estimated that the annual costs for 21 additional cases of UA in terms of annual treatment and readmission would be more than RM400,000. Treatment with ticagrelor would thereby be associated with lesser number of MACE that can be translated in avoiding annual costs of treatment of UA and result in annual cost savings of RM238,856. Conclusion:Although direct comparisons were not made, this analysis suggests that ticagrelor therapy may be a more cost-saving alternative to clopidogrel in Malaysian patients with ACS.