Cost-Effectiveness of Ticagrelor for Acute Coronary Disease to Prevent Cardiovascular Events in Three Hospitals in Indonesia

Abstract

Background: Acute coronary syndromes (ACS) are life-threatening CVD associated with Indonesia's significant health and economic burdens. The study objective was to evaluate the cost-effectiveness of ticagrelor in reducing CV endpoint in the Indonesia setting.
 Methods: Markov model was used as a decision analysis to compare ticagrelor with clopidogrel. We constructed decision tree model included four health conditions (no additional events, non-fatal myocardial infarction, non-fatal stroke, and any cause death), The probability of each state and quality-adjusted life years were derived from the PLATO trial and Indonesia life table. The outcome's resource consumption and associated costs were collected from three hospitals (public, national referral, and private hospitals) in Indonesia. The study used 5 years and lifetime horizon and discounting rate of 3%.
 Results: The incremental QALYs and life-year gained (LYG) of ticagrelor in five years was 0.0410 and 0.0462, respectively; in a lifetime was 0.0828, and 0.0947, respectively. The ICER per QALY of ticagrelor versus clopidogrel in private, national referral, and public hospitals was USD 2390.276, USD 3813.638, USD 1278.361, respectively for five years; and USD 2471.392, USD 5453.987, USD 2343.269, respectively for a lifetime. The probability of ticagrelor to be cost-effective was about 66.6% on a five-year and 99.7% on a lifetime with WTP USD 3634.
 Conclusion: Compared to the clopidogrel, QALYs and life-year gained of use ticagrelor higher. The incremental cost-effectiveness ratio in five years and lifetime model showed under one-time GDP, it means the use of ticagrelor was vastly cost-effective and acceptable to apply in the Indonesian clinical setting.

Cost-effectiveness of non-communicable disease prevention in Southeast Asia: a scoping review

“…In our scoping review, we included 42 CEAs comparing one or more interventions (Figure 1), consisting of individual (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and T2DM (high-risk) individuals (16,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) to smoking cessation programs (42)(43)(44)(45)(46)(47); or discouragement of smoking or an unhealthy diet through taxation (38,39,42,46,(48)(49)(50)(51); or health education (16,20,46, 49-52) (Figure 2). We found no CEA that focused on the harmful use of alcohol or physical inactivity.…”

“…All studies considered stroke prevention (21,22,(24)(25)(26)29), except one which evaluated treatment for heart failure patients with reduced ejection fraction (17,28,30,57). The majority of these studies showed that the interventions were cost-effective (22,(24)(25)(26)29).…”

“…Four studies are related to Acute Coronary Disease or heart failure (17,28,30,57). All of them were found to be cost-effective interventions, except one scenario in the study of Mendoza et al (28).…”

“…Krittayaphong and Permsuwan (17) evaluated treatment for heart failure patients with reduced ejection fraction and showed that add-on dapagliflozin treatment was costeffective compared with standard therapy. At Thobari et al (30) found that Ticagrelor was vastly more cost-effective compared to clopidogrel in treatment for acute coronary disease to prevent cardiovascular events in the Indonesian setting. Krittayaphong and Permsuwan (57) reported that treating patients with acute decompensated heart failure with Sacubitril-valsartan was costeffective when compared to enalapril.…”

A cost-utility analysis comparing transcatheter and surgical pulmonary valve replacement among Indonesia patients with a history of newborn right ventricular outflow tract correction

“…Furthermore, total actual costs and clinical parameters plugged into a hypothetical cohort simulation to obtain incremental cost-effective ratio (ICER) by dividing cost per quality-adjusted life-years (QALYs) gained. The ICER threshold that has been established for acceptable cost-effective in Indonesia is 1-time of GDP/capita in which 1 GDP is 3900 USD (57,816,525IDR) 54 . All outcomes of being interest beyond the annual rate of the model were discounted at 3% as recommended by Indonesian HTA guideline 55 .…”