Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study

Nikolic, Elisabet; Janzon, Magnus; Hauch, Ole; Wallentin, Lars; Henriksson, Martin

doi:10.1093/eurheartj/ehs149

Cited by 99 publications

(114 citation statements)

References 23 publications

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“…Our conclusions coincide with those of several economic evaluations comparing ticagrelor and clopidogrel for acute coronary syndrome treatment (10,(16)(17)(18). The studies suggest that, although ticagrelor was associated with higher costs, the reductions in mortality and morbidity result in its ICER falling below conventional threshold values, including those recommended by the World Health Organization.…”

Section: Discussionsupporting

confidence: 87%

Análisis de costo efectividad del ticagrelor en comparación con el clopidogrel, para el tratamiento de pacientes con síndrome coronario agudo en Colombia

Mejía¹,

Sénior

Ceballos

et al. 2015

biomedica

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Introduction: Acute coronary syndrome is one of the most frequent medical emergencies in developing countries.Objective: To determine, from the perspective of the Colombian health system, the cost-effectiveness of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome. Materials and methods:We conducted a cost-effectiveness analysis from the perspective of the Colombian health system comparing ticagrelor and clopidogrel for the treatment of patients with acute coronary syndrome. To estimate the expected costs and outcomes, a Markov model was constructed in which patients could remain stable without experiencing new cardiovascular events, suffer from a new event, or die. For the baseline case, a 10-year time horizon and a discount ratio of 3% for costs and benefits were adopted. The transition probabilities were extracted from the PLATO (Platelet Inhibition and Patient Outcomes) clinical trial. Vital statistics were drawn from the Departmento Administrativo Nacional de Estadística (DANE) and additional information from Colombian patients included in the Access registry. To identify and measure resource use, a standard case was built by consulting guidelines and protocols. Unit costs were obtained from Colombian rate lists. A probabilistic sensitivity analysis was conducted in which costs were represented by a triangular distribution, and the effectiveness through a beta distribution. Results: In the base case, the additional cost per quality-adjusted life-year gained with ticagrelor was COP$ 28,411,503. The results were sensitive to changes in the time horizon and the unit cost of clopidogrel. For a willingness-to-pay equivalent to three times the Colombian per capita gross domestic product, the probability of ticagrelor being cost-effective was 75%. Conclusions: Ticagrelor is a cost-effective strategy for the treatment of patients with acute coronary syndrome in Colombia.

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Section: Discussionsupporting

confidence: 87%

Análisis de costo efectividad del ticagrelor en comparación con el clopidogrel, para el tratamiento de pacientes con síndrome coronario agudo en Colombia

Mejía¹,

Sénior

Ceballos

et al. 2015

biomedica

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“…Queste informazioni derivano dai risultati delle analisi economiche a 12 mesi effettuate sulla base dei risultati dello studio PLATO (7,8). Ogni singola prestazione è stata poi valorizzata considerando la rispettiva tariffa rimborsata dal SSN (16).…”

Section: Esamiunclassified

“…La Tabella III, utilizzando anch'essa come fonte i risultati delle analisi economiche a 12 mesi (7,8), descrive la tipologia, la frequenza e il costo degli interventi chirurgici che vengono mediamente effettuati per un paziente con SCA. Poiché, facendo riferimento al contesto nazionale, ognuno degli interventi chirurgici indicati nella Tabella III viene effettuato durante un ricovero ospedaliero, la valorizzazione di questa prestazione sanitaria è avvenuta associando il corrispondente DRG (tariffa) rimborsato dal SSN (17).…”

Section: Interventi Chirurgiciunclassified

Analisi di Budget Impact di Ticagrelor nel Trattamento di Prevenzione in Pazienti con Sindrome Coronarica Acuta

Perna

Ravasio²,

Ricciardelli

2017

Global & Regional Health Technology Assessment

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Budget impact analysis of ticagrelor for preventive treatment of patients with acute coronary syndromes Background: Ticagrelor 90 mg BID is indicated for the prevention of thrombotic cardiovascular events in patients with acute coronary syndromes (ACS). Outcomes from the PLATO trial demonstrated that ticagrelor + ASA reduced the rate of a combined endpoint of cardiovascular death, myocardial infarction, or stroke compared to clopidogrel + ASA. Objective: This analysis estimated the budget impact of the use of ticagrelor and clopidogrel for the prevention of thrombotic cardiovascular events in patients with ACS in Italy, based on the PLATO trial results. Methods: A budget-impact model (BIM) was developed to estimate the direct costs up to 12 months after an ACS event from the Italian NHS perspective. Resource utilization (drugs, screening, monitoring, hospitalizations and transfusions) was derived from the PLATO trial. Only direct medical costs were considered. Ex-factory prices (including all discounts) and National Tariffs were used to estimate the costs of drugs and medical resource, respectively. The BIM showed the difference in expenditure and cardiovascular events (myocardial infarction and cardiovascular death -PLATO trial) generated by the base case as calculated for current prescription volumes (ticagrelor 50.6%, clopidogrel 49.4%), and for different prescription volume scenarios (ticagrelor at 75% and 100%). Key variables were tested in the sensitivity analysis. Results: Ticagrelor was associated with a medical cost offset driven by fewer hospitalizations; this partly offsets the incremental drug cost and results in an annual incremental cost per patient of €32.53 (€11,526.03 for ticagrelor and €11,493.50 for clopidogrel). Based on data from the PLATO trial, the incidence of ACS and current prescription volumes in Italy, the BIM predicts that the total number of cardiovascular events and costs are 6,169 and €652.3M, respectively. The BIM predicts that ticagrelor is associated with 550 fewer cardiovascular events at an incremental cost of €8.8M compared to generic clopidogrel. The impact of total annual costs for the Italian NHS would be limited if ticagrelor prescription volumes would be higher. The total cost is predicted to increase by 0.07% if ticagrelor prescription goes up to 75%, while the reduction of cardiovascular events is estimated to be considerably lower than -4.9%. Conclusions: Utilization of ticagrelor, as an alternative to generic clopidogrel to prevent cardiovascular events in patients with ACS, could represent an effective, low-cost treatment option for the Italian NHS. Keywords: ACS, Budget impact, Cost, Ticagrelor IntroduzioneLe sindromi coronariche acute (SCA) costituiscono una delle principali cause di mortalità e morbilità, contribuendo a causare circa il 20% di tutti i decessi (1, 2). Il principale meccanismo fisiopatologico che determina l'evento coronarico acuto è costituito dall'occlusione coronarica aterotrombotica (parziale o completa) che, a sua volta, genera una riduzione...

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“…A recent healtheeconomic analysis based on the PLATO study concluded that treating patients with ACS with ticagrelor for 12 months is associated with a cost per QALY (quality-adjusted life year) below generally accepted thresholds for cost-effectiveness. 48 …”

Section: Newer P2y12 Receptor Inhibitorsmentioning

confidence: 99%

Almanac 2012: Interventional cardiology

Meier

2013

Revista Portuguesa de Cardiologia (English Edition)

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The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multivessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including alcohol septal ablation for hypertrophic obstructive cardiomyopathy, etc. At the moment, the fastest growing area is the structural interventions, especially for aortic valve stenosis (transcatheter aortic valve implantation TAVI) and for mitral regurgitation (mitral clipping). This review covers recent advances in all these different fields of interventional cardiology. PERCUTANEOUS CORONARY INTERVENTION VERSUS MEDICAL TREATMENTPercutaneous coronary intervention (PCI) has guideline recommendations for treatment of ST elevation and non-ST elevation myocardial infarction (MI). 1 However, its role in stable coronary disease has been the subject of reappraisal following publication of the COURAGE trial, which showed that, in patients receiving optimal medical therapy, PCI does not improve cardiovascular outcomes, while incremental benefits for quality of life disappear by 36 months. A more recent meta-analysis of eight trials of optimal medical therapy versus PCI involving 7229 patients bears out the COURAGE conclusions by showing no significant differences between the groups with regard to death (9.1% vs 8.9%), non-fatal MI (8.1% vs 8.9%), unplanned revascularisation (30.7% vs 21.4%) and persistent angina (33% vs 29%).4 Drug-eluting stents (DESs) were used in only a minority of these patients and may have reduced the need for further revascularisation while improving symptomatic responses. Nevertheless, the meta-analysis reinforces contemporary guideline advice for optimal medical treatment as the initial treatment for stable angina.

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Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study

Abstract: Based on clinical and health-economic evidence from the PLATO study, treating ACS patients with ticagrelor for 12 months is associated with a cost per QALY below generally accepted thresholds for cost-effectiveness. ClinicalTrials.gov Identifier: NCT00391872.

Cited by 99 publications

References 23 publications

Análisis de costo efectividad del ticagrelor en comparación con el clopidogrel, para el tratamiento de pacientes con síndrome coronario agudo en Colombia

Análisis de costo efectividad del ticagrelor en comparación con el clopidogrel, para el tratamiento de pacientes con síndrome coronario agudo en Colombia

Analisi di Budget Impact di Ticagrelor nel Trattamento di Prevenzione in Pazienti con Sindrome Coronarica Acuta

Almanac 2012: Interventional cardiology

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