Cost-effectiveness of Platelet Function-Guided Strategy with Clopidogrel or Ticagrelor

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.

Population pharmacokinetic‐pharmacodynamic modeling of clopidogrel for dose regimen optimization based on CYP2C19 phenotypes: A proof of concept study

“…Nevertheless, dual antiplatelet therapy with clopidogrel and aspirin remains the standard of care for preventing recurrent ischemic events in patients undergoing percutaneous coronary intervention 40 . Clopidogrel is also reportedly associated with a lower bleeding risk than the more recently introduced platelet inhibitors and is less expensive 41 . Hence, personalized clopidogrel dosing regimens for PMs are needed.…”

“… 40 Clopidogrel is also reportedly associated with a lower bleeding risk than the more recently introduced platelet inhibitors and is less expensive. 41 Hence, personalized clopidogrel dosing regimens for PMs are needed.…”

Exploring the potential cost-effectiveness of a novel platelet assay for guiding dual antiplatelet therapy duration in acute coronary syndrome patients following percutaneous coronary intervention

“…Most recently, Lomakin et al . [44] compared platelet function-guided drug selection with universal clopidogrel or ticagrelor and found the guided strategy to be of high economic value (ICER for assay-guided prasugrel vs. universal clopidogrel = $14 460; ICER for assay-guided ticagrelor vs. universal clopidogrel = $16 993).…”

“…A similar study by Straub et al[43] found that platelet-function-guided P2Y 12 inhibitor selection was more cost-effective, relative to universal clopidogrel, than were universal ticagrelor or universal prasugrel. Most recently, Lomakin et al[44] compared platelet function-guided drug selection with universal clopidogrel or ticagrelor and found the guided strategy to be of high economic value (ICER for assay-guided prasugrel vs. universal clopidogrel = $14 460; ICER for assayguided ticagrelor vs. universal clopidogrel = $16 993). MI.…”

Personalised Approaches to Improving the Effect of Anti-platelet Agents: Where Do We Stand?

“…In the current edition of European Cardiology Review, a simulated analysis of DAPT post-ACS driven by testing for platelet reactivity gives some hope that a personalised approach to anti-platelet therapy is still worth exploring. 9 We believe that the randomised trial evidence mentioned above is too convincing to resurrect this approach. p=0.002 for the presence of two LOF alleles).…”