Healthcare Resource Utilization Among Ticagrelor-Treated Patients With Bleeding or Undergoing Urgent Surgery in the United States: A Real-World, Retrospective Claims Analysis
Moderator
John Fanikos, Vasculearn Network, Wakefield, MA, United States
Speakers
Ralph Riello; Jacquelyn Evans-Shields, PharmD, Directorie, Chesterfield, MO, United States; Christina England; John McKenney
OBJECTIVES: Describe bleeding and surgery-related healthcare resource utilization (HCRU) among a cohort of patients with ACS treated with ticagrelor. Ticagrelor is a potent P2Y12 inhibitor prescribed to reduce ischemic events in acute coronary syndrome (ACS) but can increase bleeding risk. Unlike irreversible thienopyridines, ticagrelor reversibly antagonizes ADP-mediated platelet activation such that reversal attempts with platelet transfusion confers limited benefit. Without a ticagrelor-specific antidote, there remains an unmet need to determine the healthcare burden of patients with major bleeding or requiring urgent surgery.
METHODS: IBM MarketScan Commercial, Medicare, and Medicaid claims databases were queried for ticagrelor treated patients between 2014 and 2018 with ≥1 year of continuous benefits enrollment and persistent (no refill gap ≥30 days) adherence. Outcomes of interest include all-cause, gastrointestinal, and intracranial hemorrhage (ICH) bleeding as well as urgent surgery. Bleeding events were identified by diagnosis codes within administrative claims; treatment included transfusions or other reversal strategies on the same claim. Urgent surgeries were identified via procedure codes, defined as minor and major therapeutic or diagnostic procedures; urgency was presumed for any inpatient stay with ambulance arrival or emergency room claim. HCRU was assessed for each event type across ticagrelor-treated patients’ continuum of care.
RESULTS: 23,045 commercial 7,787 Medicare, and 3,110 Medicaid patients initiated ticagrelor. All-cause bleeding events were associated with $19,809±$64,462 in HCRU among the commercial cohort with $29,976±$79,005 for bleeding treatment. ICH was associated with highest costs ($73,948±$91,540), while treatment for ICH was $128,304 ±$117,198. The HCRU for patients requiring urgent procedures were $34,148 ±$75,759 per event.
CONCLUSIONS: HCRU associated with bleeding or surgical intervention among ticagrelor-treated patients was similarly substantial among payer types. A specific ticagrelor antidote that rapidly restores platelet function during bleeding, while balancing perioperative thrombosis risk, may offer a potential solution for this complex, costly ACS population.
METHODS: IBM MarketScan Commercial, Medicare, and Medicaid claims databases were queried for ticagrelor treated patients between 2014 and 2018 with ≥1 year of continuous benefits enrollment and persistent (no refill gap ≥30 days) adherence. Outcomes of interest include all-cause, gastrointestinal, and intracranial hemorrhage (ICH) bleeding as well as urgent surgery. Bleeding events were identified by diagnosis codes within administrative claims; treatment included transfusions or other reversal strategies on the same claim. Urgent surgeries were identified via procedure codes, defined as minor and major therapeutic or diagnostic procedures; urgency was presumed for any inpatient stay with ambulance arrival or emergency room claim. HCRU was assessed for each event type across ticagrelor-treated patients’ continuum of care.
RESULTS: 23,045 commercial 7,787 Medicare, and 3,110 Medicaid patients initiated ticagrelor. All-cause bleeding events were associated with $19,809±$64,462 in HCRU among the commercial cohort with $29,976±$79,005 for bleeding treatment. ICH was associated with highest costs ($73,948±$91,540), while treatment for ICH was $128,304 ±$117,198. The HCRU for patients requiring urgent procedures were $34,148 ±$75,759 per event.
CONCLUSIONS: HCRU associated with bleeding or surgical intervention among ticagrelor-treated patients was similarly substantial among payer types. A specific ticagrelor antidote that rapidly restores platelet function during bleeding, while balancing perioperative thrombosis risk, may offer a potential solution for this complex, costly ACS population.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE43
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Injury & Trauma, STA: Surgery