OBJECTIVES

Clopidogrel and ticagrelor are two widely prescribed P2Y₁₂ receptor inhibitors in China. Our study aims to examine the life-long clinical and economic impacts of receiving ticagrelor versus clopidogrel for antiplatelet treatment in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

METHODS

A decision-analytic model was developed to simulate two antiplatelet treatment strategies: universal clopidogrel (75mg daily) and universal ticagrelor (90mg twice daily) in a hypothetical 60-year-old ACS patients with PCI. Published literature were the main sources of model inputs. Direct medical costs and quality-adjusted life-years (QALYs) gained were the primary outcome measures in each option from the perspective of healthcare system in China. One-way and probabilistic sensitivity analyses were performed to evaluate the robustness of model results.

RESULTS

Base-case analysis illustrated that universal ticagrelor gained more QALYs (7.3566 versus 7.2902 QALYs) at higher cost (USD31,210 versus USD30,199) compared to universal clopidogrel. The incremental cost-effectiveness ratio (ICER) of ticagrelor versus clopidogrel was 15,226 USD/QALY below the willingness-to-pay threshold of 29580 USD/QALY in China, therefore, universal ticagrelor was cost-effective. One-way sensitivity analysis showed the most influential parameters on base-case results were odds ratio of cardiovascular death of ticagrelor versus clopidogrel, monthly cost of generic clopidogrel, odds ratio of nonfatal myocardial infarction of ticagrelor versus clopidogrel, and mortality rate of cardiovascular death of patients receiving clopidogrel. Universal clopidogrel would be cost-effective if the odds ratio of cardiovascular death of ticagrelor versus clopidogrel exceeded 0.907. In probabilistic sensitivity analysis, the probabilities of universal ticagrelor and universal clopidogrel to be cost-effective were 92.05% and 7.95% of 10,000 Monte Carlo simulations.

CONCLUSIONS

Universal ticagrelor appears to be cost-effective as compared with universal clopidogrel in ACS patients with PCI.