Cost-Effectiveness of Treating Acute Coronary Syndrome Patients With Ticagrelor for 12 Months: Results From the PLATO Study

Study Questions:

What is the long-term cost-effectiveness of treating acute coronary syndrome (ACS) patients for 12 months with ticagrelor compared with generic clopidogrel?

Methods:

Event rates, health care costs, and health-related quality of life during 12 months of therapy with either ticagrelor or generic clopidogrel were estimated from the PLATO study. Beyond 12 months, quality-adjusted survival and costs were estimated conditional on whether a nonfatal myocardial infarction (MI), a nonfatal stroke, or no MI or stroke occurred during the 12 months of therapy. Lifetime costs, life expectancy, and quality-adjusted life years (QALYs) were estimated for both treatment strategies. Incremental cost-effectiveness ratios were presented from a health care perspective in 2010 Euros (€) applying unit costs and life tables from a Swedish setting in the base-case analysis.

Results:

Treatment with ticagrelor was associated with increased health care costs of €362 and a QALY gain of 0.13 compared with generic clopidogrel, yielding a cost per QALY gained with ticagrelor of €2753. The cost per life-year gained was €2372. The results were consistent in major subgroups. Sensitivity analyses showed a cost per QALY gained with ticagrelor of approximately €7300 under certain scenarios.

Conclusions:

The authors concluded that 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.

Perspective:

The results of the cost-effectiveness analysis show that treatment with ticagrelor is associated with a cost per QALY of approximately €2800 when compared with generic clopidogrel. This finding was consistent across major subgroups, indicating that treating ACS patients with ticagrelor compared with generic clopidogrel will improve quality-adjusted survival at a cost below generally acceptable thresholds for cost-effectiveness. The generalizability of the PLATO design to clinical practice, together with the fact that the cost-effectiveness results appear robust to data sources that could potentially differ between countries, imply that the cost per QALY gained with ticagrelor may be below conventional thresholds for cost-effectiveness in most European settings. Additional real-world data are indicated to further validate these findings.

Clinical Topics: Acute Coronary Syndromes

Keywords: Myocardial Infarction, Stroke, Cost-Benefit Analysis, Acute Coronary Syndrome, Platelet Aggregation Inhibitors, Transcription Factors, Ticlopidine, Health Care Costs, Purinergic P2Y Receptor Antagonists, Endocarditis, Cardiovascular Diseases, Organoplatinum Compounds, Quality-Adjusted Life Years, Troponin


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