Abstract
ObjectivesTo evaluate the long-term cost-effectiveness of ticagrelor and ASA versus generic and branded clopidogrel and ASA in patients with ACS based on a Thai cost database.MethodsA one-year decision tree and a long-term Markov model were constructed to estimate lifetime costs and quality-adjusted life years (QALYs). For the first year, data from PLATO (NCT00391872) were used to estimate the rate of cardiovascular events, resource use, and QALYs. For year 2 onwards, clinical effectiveness was estimated conditional on individual health states that occurred during the first year.ResultsIn the base-case analysis, the incremental cost-effectiveness ratio (ICER) with ticagrelor was 292,504 ($9,476) and 60,055 ($1,946) THB($)/QALY compared with generic and branded clopidogrel, respectively. The probability of ticagrelor being cost-effective was above 99% at a threshold of 160,000 THB/QALY compared with branded clopidogrel.ConclusionsThis health economic analysis provides cost effectiveness data for ticagrelor compared with both generic and branded clopidogrel in Thailand. Based on this analysis, it appears that ticagrelor is an economically valuable treatment for ACS compared with branded clopidogrel within the Thai context.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0017-3) contains supplementary material, which is available to authorized users.
Highlights
Acute coronary syndrome (ACS) is a common cardiovascular disease associated with high complication and mortality rates
The difference in cost was less marked in analyses using branded versus generic clopidogrel (6,553 vs 31,918 THB respectively) resulting in a lower incremental cost-effectiveness ratio (ICER) of branded clopidogrel than generic clopidogrel (60,055 vs 292,504 THB/quality-adjusted life years (QALYs) respectively) compared with ticagrelor (Table 5)
Sensitivity analysis Of the 26 variables tested in one-way sensitivity analyses, we found that the cost of clopidogrel, the cost of the no-event state within the trial of both ticagrelor and clopidogrel, and the hazard ratio (HR) of standard mortality in the noevent state had the greatest impact on ICER (Figure 2)
Summary
Acute coronary syndrome (ACS) is a common cardiovascular disease associated with high complication and mortality rates. From the Thai ACS Registry – a survey conducted at 17 tertiary care centers in 2007 – the inhospital mortality rate was 12.6% [1]. A later survey in 2012 showed a lower rate of in-hospital mortality (4.8%) but the mortality rate at one-year had not decreased (17.7%) [2]. A study of ACS patients under the Universal Coverage (UC) scheme and Civil Servant Medical Benefits Scheme (CSMBS) at all levels of hospital found that the in-hospital mortality rate was approximately 14%, and that ACS was associated with substantial health care use and costs [3,4]. Various anti-platelet drugs have been proven to reduce cardiovascular events in ACS patients.
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