OBJECTIVES:

To evaluate the budget impact (BI) of increase Prasugrel prescription versus Ticagrelor and Clopidogrel in the treatment of patients with acute coronary syndrome undergoing Percutaneous Coronary Intervention from a Spain healthcare payer perspective.

METHODS:

A BI model was developed to capture drug and clinical events (acute myocardial infarction, stroke, Urgent Target Vessel Revascularization (UTVR) and major/minor bleeding) costs (€ 2017) over a 3-year period. The scenarios evaluated were I) current scenario based on Spanish market research data from 2016, II) increase prasugrel prescription only or III) increase prasugrel and ticagrelor. Using available data with clinical cost data for hospital and outpatient procedures and pharmaceutical costs, the model reported on the economic differences associated with the three scenarios. The resulting cost per patient, cost differences and results of a 1-way sensitivity analysis are reported.

RESULTS:

The total impact after 3 years is € 229M for scenario I, € 241M for scenario II and € 257M for scenario III, which is equivalent to increases of 5.5% and 12.5%, respectively. The greater incorporation of prasugrel and ticagrelor leads to reduced events and the cost of myocardial infarctions (€ -5.2M, -6.12% scenario II vs I, € -10.5M, -12.34% Scenario III vs I), stroke (€ -0.74M, -6.42% scenario II vs I, € -0.71M, -6.15% scenario III vs I) and the UTVR (€ - 4.3M, -8.19% scenario II vs I,€ -2.4M, -4.55% scenario III vs. I). The higher incorporation of ticagrelor increase the cost related to bleedings. On the other hand, the cost per patient of prasugrel is lower than ticagrelor (€ 1,212.76 vs € 1,518.75) cost due to lower pharmacological cost and fewer events such as UTVR, stroke and bleeding.

CONCLUSIONS:

This study provides additional health economic rationale for boost prasugrel prescription, due to the reduction of clinical events rate with marginal BI.