Ticagrelor versus Genotype-Driven Antiplatelet Therapy for Secondary Prevention after Acute Coronary Syndrome- A Cost-Effectiveness Analysis

Jun 1, 2011, 00:00
10.1016/j.jval.2010.11.012
https://www.valueinhealthjournal.com/article/S1098-3015(10)00081-1/fulltext
Title : Ticagrelor versus Genotype-Driven Antiplatelet Therapy for Secondary Prevention after Acute Coronary Syndrome- A Cost-Effectiveness Analysis
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(10)00081-1&doi=10.1016/j.jval.2010.11.012
First page : 483
Section Title : Economic Evaluation
Open access? : No
Section Order : 10

Background

Clopidogrel's effectiveness is likely reduced significantly for prevention of thrombotic events after acute coronary syndrome (ACS) in patients exhibiting a decreased ability to metabolize clopidogrel into its active form. A genetic mutation responsible for this reduced effectiveness is detectable by genotyping. Ticagrelor is not dependent on gene-based metabolic activation and demonstrated greater clinical efficacy than clopidogrel in a recent secondary prevention trial. In 2011, clopidogrel will lose its patent protection and likely will be substantially less expensive than ticagrelor.

Objective

To determine the cost-effectiveness of ticagrelor compared with a genotype-driven selection of antiplatelet agents.

Methods

A hybrid decision tree/Markov model was used to estimate the 5-year medical costs (in 2009 US$) and outcomes for a cohort of ACS patients enrolled in Medicare receiving either genotype-driven or ticagrelor-only treatment. Outcomes included life years and quality-adjusted life years (QALYs) gained. Data comparing the clinical performance of ticagrelor and clopidogrel were derived from the Platelet Inhibition and Patient Outcomes trial.

Results

The incremental cost-effectiveness ratio (ICER) for universal ticagrelor was $10,059 per QALY compared to genotype-driven treatment, and was most sensitive to the price of ticagrelor and the hazard ratio for death for ticagrelor compared with clopidogrel. The ICER remained below $50,000 per QALY until a monthly ticagrelor price of $693 or a 0.93 hazard ratio for death for ticagrelor relative to clopidogrel. In probabilistic analyses, universal ticagrelor was below $50,000 per QALY in 97.7% of simulations.

Conclusion

Prescribing ticagrelor universally increases quality-adjusted life years for ACS patients at a cost below a typically accepted threshold.

Categories :
  • Cardiovascular Disorders
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision Modeling & Simulation
  • Economic Evaluation
  • Specific Diseases & Conditions
  • Study Approaches
Tags :
  • acute coronary syndrome
  • clopidogrel
  • cost-benefit analysis
  • secondary prevention
  • ticagrelor
Regions :
  • North America
ViH Article Tags :