OBJECTIVES: Percutaneous coronary intervention (PCI)-related complications can lead to increased hospital costs due to longer hospital stays, readmissions, and the need for new revascularization. Cangrelor is a safe and effective, intravenous P2Y12 platelet inhibitor with fast onset and offset of action which reduces the risk of PCI-related complications. A systematic literature review (SLR) was conducted to assess the economic evidence on cangrelor in PCI.

METHODS: MEDLINE^®, EMBASE^® and grey literature databases were searched using PICO-S-T-related keywords. Full texts published from 2009 and abstracts from 2019 were assessed against pre-defined inclusion criteria. Economic studies were extracted and quality-assessed using the CHEERS checklist.

RESULTS: Of the included 47 papers, seven studies included economic outcomes: four budget impact analyses, two cost-consequence models and one observational study. These evaluated the following outcomes: hospital length of stay, hospital costs and annual budget impact of introducing cangrelor to hospital formularies. Budget impact analyses from the National Health System perspectives demonstrated that cangrelor introduction provided an affordable budget impact of €115,000, €500,000, €1million and €1.1million (Portugal, Germany, Spain, Belgium, respectively) over three years and reduced the number of patients on glycoprotein IIb/IIIa inhibitors (GPIs). A US cost-consequence analysis showed that increasing cangrelor use from 11 to 32% over three years provided a reduction in hospital annual costs of $144,919 with 50% reduced P2Y12 pre-treatment, and savings increased with no pre-treatment. Savings were attributable to a reduction in ischemic events, decrease in GPI use and shortened P2Y12 inhibitor washout period. Observational evidence from the US indicates that hospital length of stay, including intensive care, was significantly reduced by 0.8 days with cangrelor compared with GPIs.

CONCLUSIONS: Economic evidence in the US and Europe shows that cangrelor has an affordable budget impact and provides savings at the hospital level by reducing costs associated with periprocedural ischemic events and reducing delays in further surgeries.