OBJECTIVES: Cangrelor is a novel, intravenous, potent, fast onset, direct-acting, P2Y₁₂ receptor antagonist that blocks adenosine diphosphate-induced platelet activation and aggregation with a half-life of 3-6 min. Co-administered with acetylsalicylic acid, it is indicated for reducing thrombotic cardiovascular events in patients with coronary artery disease (CAD) (ST-elevation myocardial infarction (STEMI), non-STEMI, stable CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y₁₂ inhibitor prior to PCI procedure and in whom oral therapy with P2Y₁₂ inhibitors is not feasible or desirable. The objective was to assess the economic implications of introducing cangrelor into the current acute formulary set up in Spain.

METHODS: Budget impact model (BIM) based on the pharmacological and clinical event costs, to calculate the cost implications for two acute formulary scenarios: with and without cangrelor, at 3 year-time horizon. Scenario without cangrelor considered the use of oral P2Y₁₂ and glycoprotein IIb-IIIa inhibitors (GPI) only. Epidemiological, efficacy (stent thrombosis, myocardial infarction (MI), ischaemia-driven revascularization, death), safety (Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria) and costs (€, 2019) data were based on Spanish registries, clinical trials and meta-analyses. One-way sensitivity analysis established the effect of predefined parameters uncertainty on BIM results.

RESULTS: The PCI population would grow from 74,217 to 77,768 adults (2019-2021) in Spain. If cangrelor uptake reaches 12% at year 3, 38 stent thrombosis, 130 MI, 22 deaths and 14 major bleedings would be averted within 48 hours of PCI. At year 3, the percentage of budget impact would be 1.09% due to pharmacological costs, partially offset by costs avoided from decreasing adverse cardiac events (ACE). Results are most sensible to length of hospital stay after PCI and to percentage of patients on GPI.

CONCLUSIONS: Under BIM assumptions, the use of cangrelor in CAD patients undergoing PCI reduces 48 hours ACE and may represent an affordable option in Spain.