OBJECTIVES: Acute coronary syndrome patients on dual antiplatelet therapy needing emergent or urgent cardiac surgery are at risk of major bleeding, which can impair post-operative outcomes. CytoSorb^®, a blood purification, adsorbent polymer technology, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery. This study assessed the cost-utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery.

METHODS: A de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources were used to inform the model. Costs were estimated from the National Health Service (NHS) and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSA) explored the uncertainty surrounding the input parameters.

RESULTS: In emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb is less costly (£12,940 versus £16,886) and more effective (0.06201 versus 0.06076 quality-adjusted life years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, use of CytoSorb was less costly than any of the three comparators; delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low molecular-weight heparin. Results from the PSA showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53%-77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in hospital/intensive care unit. Using CytoSorb could save the NHS 3,195 hospital bed days per year.

CONCLUSIONS: Implementation of CytoSorb intraoperatively for patients on ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use.