Pcv85 Prasugrel vs. Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Spanish Model-Based Cost-Effectiveness Analysis

Davies, Allan; Sculpher, M; Barrett, Amy; Valladares, Alejandro Varela; Huete, T.; Dilla, Tatiana

doi:10.1016/s1098-3015(11)72428-7

Cited by 2 publications

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“…[74][75][76] In the MS (p. 87), the manufacturer comments that the results of the analyses described in the full paper 72 were generated by the same model as that submitted to NICE for the evaluation of prasugrel in 2009 (TA182). 21 This reference was therefore excluded from the review by the AG as the economic model described therein has been previously fully discussed and critiqued.…”

Section: 74-76mentioning

confidence: 99%

“…However, as the full paper 72 reports model results using costs and rehospitalisation rates specific to Germany, Sweden, the Netherlands and Turkey, the AG has reproduced the table of results from the main study 72 and also the results of a sensitivity analysis where the price of clopidogrel has been set to zero ( Table 15). The results of the Spanish model-based cost-effectiveness analysis presented in one of the abstracts have not been presented here as the abstract 76 did not include sufficient population data to allow comparison with the other published model results. In summary, all of the individual country incremental cost-effectiveness ratio (ICER) estimates demonstrate the cost-effectiveness of prasugrel compared with clopidogrel in the overall licensed population and in four patient subgroups (UA/NSTEMI, STEMI, ACS diabetes and the core clinical cohort); when the price of clopidogrel is set to zero, prasugrel remains cost-effective compared with clopidogrel in the overall licensed population.…”

Section: 74-76mentioning

confidence: 99%

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Prasugrel (Efient®) with percutaneous coronary intervention for treating acute coronary syndromes (review of TA182): systematic review and economic analysis

Greenhalgh

Bagust

Boland

et al. 2015

Health Technology Assessment

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BackgroundAcute coronary syndromes (ACSs) are life-threatening conditions associated with acute myocardial ischaemia. There are three main types of ACS: ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina (UA). One treatment for ACS is percutaneous coronary intervention (PCI) plus adjunctive treatment with antiplatelet drugs. Dual therapy antiplatelet treatment [aspirin plus either prasugrel (Efient®, Daiichi Sankyo Company Ltd UK/Eli Lilly and Company Ltd), clopidogrel or ticagrelor (Brilique®, AstraZeneca)] is standard in UK clinical practice. Prasugrel is the focus of this review.ObjectivesThe remit is to appraise the clinical effectiveness and cost-effectiveness of prasugrel within its licensed indication for the treatment of ACS with PCI and is a review of National Institute for Health and Care Excellence technology appraisal TA182.Data sourcesFour electronic databases (MEDLINE, EMBASE, The Cochrane Library, PubMed) were searched from database inception to June 2013 for randomised controlled trials (RCTs) and to August 2013 for economic evaluations comparing prasugrel with clopidogrel or ticagrelor in ACS patients undergoing PCI.MethodsClinical outcomes included non-fatal and fatal cardiovascular (CV) events, adverse effects of treatment and health-related quality of life (HRQoL). Cost-effectiveness outcomes included incremental cost per life-year gained and incremental cost per quality-adjusted life-year (QALY) gained. An independent economic model assessed four mutually exclusive subgroups: ACS patients treated with PCI for STEMI and with and without diabetes mellitus and ACS patients treated with PCI for UA or NSTEMI and with and without diabetes mellitus.ResultsNo new RCTs were identified beyond that reported in TA182. TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel Thrombolysis in Myocardial Infarction 38) compared prasugrel with clopidogrel in ACS patients scheduled for PCI. No relevant economic evaluations were identified. Our analyses focused on a key subgroup of patients: those aged < 75 years who weighed > 60 kg (no previous stroke or transient ischaemic attack). For the primary composite end point (death from CV causes, non-fatal myocardial infarction or non-fatal stroke) statistically significantly fewer events occurred in the prasugrel arm (8.3%) than in the clopidogrel arm (11%). No statistically significant difference in major bleeding events was noted. However, there was a significant difference in favour of clopidogrel when major and minor bleeding events were combined (3.0 vs. 3.9%). No conclusions could be drawn regarding HRQoL. The results of sensitivity analyses confirmed that it is likely that, for all four ACS subgroups, within 5–10 years prasugrel is a cost-effective treatment option compared with clopidogrel at a willingness-to-pay threshold of £20,000 to £30,000 per QALY gained. At the full 40-year time horizon, all estimates are < £10,000 per QALY gained.LimitationsLack of data precluded a clinical comparison of prasugrel with ticagrelor; the comparative effectiveness of prasugrel compared with ticagrelor therefore remains unknown. The long-term modelling exercise is vulnerable to major assumptions about the continuation of early health outcome gains.ConclusionA key strength of the review is that it demonstrates the cost-effectiveness of prasugrel compared with clopidogrel using the generic price of clopidogrel. Although the report demonstrates the cost-effectiveness of prasugrel compared with clopidogrel at a threshold of £20,000 to £30,000 per QALY gained, the long-term modelling is vulnerable to major assumptions regarding long-term gains. Lack of data precluded a clinical comparison of prasugrel with ticagrelor; the comparative effectiveness of prasugrel compared with ticagrelor therefore remains unknown. Well-audited data are needed from a long-term UK clinical registry on defined ACS patient groups treated with PCI who receive prasugrel, ticagrelor and clopidogrel.Study registrationThis study is registered as PROSPERO CRD42013005047.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: 74-76mentioning

confidence: 99%

Section: 74-76mentioning

confidence: 99%

Prasugrel (Efient®) with percutaneous coronary intervention for treating acute coronary syndromes (review of TA182): systematic review and economic analysis

Greenhalgh

Bagust

Boland

et al. 2015

Health Technology Assessment

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“…However, there is wide variability in PCI procedures including access site (femoral vs. radial), interventional equipment, and adjunctive medication. This variability, combined with increasingly complicated patients, can cause procedural practice variability to be associated with inefficiency and increased cost . Although the clinical benefit of PCI has been studied, and numerous PCI cost‐effectiveness analyses have been performed , a contemporary and detailed cost analysis with the goal of reducing PCI costs from the hospitals' perspective is lacking.…”

Section: Introductionmentioning

confidence: 99%

Cost awareness decreases total percutaneous coronary intervention procedural cost: The SHOPPING (Show How Options in Price for Procedures Can Be Influenced Greatly) trial

Asher

Mansour

Wheeler

et al. 2016

Cathet Cardio Intervent

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Announcing costs in the catheterization laboratory during single vessel PCI and peer reporting leads to cost reduction without affecting clinical outcomes. This intervention may have a role in more complex coronary and peripheral interventional procedures, and in other procedural areas where multiple equipment and device alternatives with variable costs are available. © 2016 Wiley Periodicals, Inc.

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Pcv85 Prasugrel vs. Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Spanish Model-Based Cost-Effectiveness Analysis

Cited by 2 publications

References 0 publications

Prasugrel (Efient®) with percutaneous coronary intervention for treating acute coronary syndromes (review of TA182): systematic review and economic analysis

Prasugrel (Efient®) with percutaneous coronary intervention for treating acute coronary syndromes (review of TA182): systematic review and economic analysis

Cost awareness decreases total percutaneous coronary intervention procedural cost: The SHOPPING (Show How Options in Price for Procedures Can Be Influenced Greatly) trial

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