The Budget Impact of Cangrelor for the Treatment of Patients Undergoing Percutaneous Coronary Intervention When Oral P2Y12 Inhibitors Are Not Feasible or Desirable in the UK

OBJECTIVES:

Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor indicated for the reduction of thrombotic cardiovascular events in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor prior to the PCI procedure, and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable.

The objective of this analysis is to estimate the UK budget impact of introducing cangrelor, for the ST-elevation myocardial infarction (STEMI) population in whom oral P2Y12 inhibitors are not feasible or desirable.

METHODS:

A budget impact model was developed to calculate the impact of introducing cangrelor to treat patients with CAD undergoing PCI for STEMI in whom oral P2Y12 inhibitors are not feasible or desirable, over 5 years. Efficacy (thrombotic events), safety (bleeding events), and cost data were based on clinical trials, literature and the British National Formulary.

Comparators in the base case were glycoprotein IIb/IIIa inhibitors (eptifibatide and tirofiban) and aspirin and heparin alone, reflecting expected use of cangrelor in UK centres. A scenario analysis including oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) as comparators was also considered. Cangrelor uptake was estimated as 10.0%, 30.0%, 50.0%, 70.0% and 90.0% in years 1-5, respectively.

RESULTS:

The cangrelor-eligible population was estimated at 2,683 patients per year based on the National Audit of PCI 2021 and expert advice. Over 5 years, cangrelor leads to a cost saving of £1,531,266 (-6.07%), varying from £64,918 in year 1 to £547,588 in year 5. Over 5 years, a total of 4,785 hospital days are predicted to be avoided.

When oral P2Y12 inhibitors were included, there was an increase to a budget impact of £1,102,586 (+4.62%).

CONCLUSIONS:

Introducing cangrelor in patients undergoing PCI for STEMI when oral P2Y12 inhibitors are not feasible or desirable may lead to cost savings in the UK.