Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis

David Bin-Chia Wu,Chun Wie Chong,June Wai Yee Choon,Kenneth Kwing Chin Lee,Benjamin Shing Cheung Lee

doi:10.11648/j.hep.20200503.13

David Bin-Chia Wu, Chun Wie Chong + Show 3 more

Open Access

https://doi.org/10.11648/j.hep.20200503.13

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Abstract

This study aimed to evaluate the long-term cost-effectiveness of ticagrelor plus aspirin versus generic clopidogrel plus aspirin in acute coronary syndrome patients in Hong Kong (HK) from a public hospital’s perspective. The study has adapted a previously developed two-component prediction model. The first component is a simple decision tree corresponding to the first year. Afterwards events in the second year onwards were estimated using a state-transition Markov model incorporating the potential of recurrent events such as myocardial infarction and strokes that could lead to death for estimating the long-term economic and health outcomes measured as cost per quality-adjusted life year (QALYs). Kaplan Meier survival analysis was employed to determine the risk of events. Probabilistic sensitivity analysis was used to estimate the probability of ticagrelor being cost-effective. A cost-effectiveness acceptability curve was used to estimate the willingness-to-pay of patients. The use of ticagrelor led to improved clinical outcomes by gaining additional life-years and QALYS over 5-year and lifetime time horizons. The incremental cost-effectiveness ratio was above 1 Gross Domestic Product (GDP) per capita only for the 1-year results. By replacing clopidogrel with ticagrelor for life-time, the incremental drug costs were offset by the substantial reduction in other direct costs, leading to an overall cost-savings of HK 2,878 per patient. The probabilistic sensitivity analysis showed that ticagrelor has 53.5% chance of being dominant and 34.7% being cost-effective at a threshold of 1 GDP per capita for Hong Kong. A cost-effectiveness acceptability curve also showed that the willingness-to-pay for ticagrelor was 90% at 1 GDP per capita. Ticagrelor plus aspirin appeared to be cost-effective over 5-year and life-time projection periods compared to clopidogrel plus aspirin.

Highlights

Since 1960s, cardiovascular diseases have been the third leading cause of death in Hong Kong [1]
Acute coronary syndrome (ACS) is a broad term with a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non– ST-segment elevation myocardial infarction (NSTEMI) or in unstable angina
Afterwards events in the second year onwards were estimated using a state-transition Markov model incorporating the potential of recurrent event such as myocardial infarction (MI) or stroke that could lead to death for estimation of the long-term economic and health outcomes measured as cost per quality-adjusted life year (QALYs)

Summary

Introduction

Since 1960s, cardiovascular diseases have been the third leading cause of death in Hong Kong [1]. Acute coronary syndrome (ACS) is a broad term with a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non– ST-segment elevation myocardial infarction (NSTEMI) or in unstable angina. As per practice guidelines by the American College of Cardiology/American Heart Association Task Force, in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), initiation of dual antiplatelet therapy of the combination aspirin and clopidogrel or aspirin and ticagrelor is recommended for up to 12 months [2]. In Hong Kong, similar guidelines are followed for the management of acute coronary syndrome. Ticagrelor is an oral antiplatelet drug indicated in patients with acute coronary syndrome to prevent. Coronary Syndrome in Hong Kong: A Cost-Utility Analysis thrombotic episodes.

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