Abstract 249: Economic Outcomes for Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention and Receiving Prasugrel or Ticagrelor: A Retrospective US Hospital Database Analysis

Abstract

Objectives: To compare all-cause healthcare resource utilization and costs with prasugrel (pras) vs. ticagrelor (ticag) with real world data in patients (pts) with ACS managed with PCI. Methods: The IMS Patient-Centric Data Warehouse was used to identify ACS-PCI pts ≥18 years with an in-hospital claim for pras or ticag (index date) between 8/1/11 and 4/30/13. The baseline period began on 1/1/08 with the follow-up period spanning until 7/29/13. The two drug groups were propensity-matched (PM) based upon demographic and clinical characteristics. Three cohorts were pre-defined and analyzed: ACS-PCI (primary cohort), ACS-PCI without prior TIA or stroke (label cohort), and ACS-PCI patients without prior TIA or stroke and if age ≥75 years required evidence of diabetes or prior MI (core cohort). Hospital specific cost:charge ratios were used to determine costs and adjusted to 2013 US dollars. Total costs were the sum of medical costs, including lab and diagnostic tests, and pharmacy costs during hospitalization. Generalized estimating equations were used to evaluate PM-adjusted differences in length of stay (LOS) and costs. Costs are reported on a per patient basis. Resource utilization and costs were assessed during index hospitalization, 30 and 90 days post-discharge. Results: 16,098 pts were in the primary cohort (pras: 13,134 [82%] and ticag: 2,964 [18%]). Compared to ticag pts, pras pts were younger, more likely men, and less likely to have cardiovascular or bleeding risk factors (P<0.05). In all 3 cohorts, unadjusted data showed that PCI characteristics (stent type, number of stents and vessels) were similar between pras and ticag, but ticag patients tended to have higher use of lab and diagnostic tests compared to pras during index hospitalization. For the index hospitalization, the unadjusted CCU/ICU and post-PCI LOS were shorter for pras vs. ticag, but overall LOS was not significantly different after adjustment. PM-adjusted mean all-cause total, medical, and pharmacy costs are presented in the table. Conclusion: Economic outcomes of ACS-PCI pts receiving pras were similar to ticag for the primary population with significant savings in total and medical costs for pts without prior TIA or stroke. These data indicate that ticag has no economic advantage compared with pras in routine clinical practice.