Healthcare Resource Utilization Among Ticagrelor-Treated Patients With Bleeding or Undergoing Urgent Surgery in the United States: A Real-World, Retrospective Claims Analysis
Author(s)
Ralph Riello, PharmD1, Jacquelyn Evans-Shields, PharmD2, Christina England, MPH3, John McKenney, BA3, John Fanikos, RPh4.
1Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, USA, 2Directorie, Chesterfield, MO, USA, 3Serb Pharmaceuticals, Conshohocken, PA, USA, 4North American Thrombosis Forum, Brigham and Women's Hospital, Boston, MA, USA.
1Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, USA, 2Directorie, Chesterfield, MO, USA, 3Serb Pharmaceuticals, Conshohocken, PA, USA, 4North American Thrombosis Forum, Brigham and Women's Hospital, Boston, MA, USA.
Presentation Documents
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