Cost-Effectiveness of Ticagrelor Relative to Clopidogrel in ACS | Journal Scan

Study Questions:

What is the cost and cost-effectiveness of ticagrelor therapy relative to clopidogrel in treating patients with acute coronary syndrome (ACS) from the perspective of the US health care system?

Methods:

The investigators estimated within-trial resource use and costs using US low-dose aspirin patients in the PLATO (Platelet Inhibition and Patient Outcomes) study (n = 547) and quality-adjusted life expectancy using the total PLATO population (n = 18,624), combined with baseline risk and long-term survival data from an external ACS patient cohort. Study drugs were valued at current costs. Cost-effectiveness was assessed, as was the sensitivity of results to sampling and methodological uncertainties.

Results:

One year of ticagrelor therapy, relative to generic clopidogrel, cost $29,665/quality-adjusted life-years gained, with 99% of bootstrap estimates falling under a $100,000 willingness-to-pay threshold. Results were robust to extensive sensitivity analyses, including variations in clopidogrel cost, exclusion of costs in extended years of life, and a recalibrated estimate of survival, reflecting a lower underlying mortality risk in the United States.

Conclusions:

The authors concluded that a ticagrelor regimen increased life expectancy at an incremental cost well within accepted benchmarks of good value for the money.

Perspective:

This study reports that ticagrelor therapy for PLATO-eligible ACS patients, in combination with low-dose aspirin, is economically attractive relative to clopidogrel from the perspective of the US health care system under a wide range of assumptions regarding health care costs and mortality benefit. Since analyses of cost-effectiveness in patient subgroups were not designed a priori, these results should be considered exploratory, but overall findings suggest that ticagrelor is cost-effective relative to other therapeutic standards. For the individual patient, however, the amount of out-of-pocket expense for this newer agent is highly variable and must be considered in assigning long-term treatment.


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