PCV26 Budget IMPACT Analysis of Antiplatelet Therapy with Cangrelor in Patients with ACUTE Coronary Artery Disease Undergoing Percutaneous Coronary Intervention in Germany

Abstract

Cangrelor is a novel, potent, intravenous, fast onset P2Y12 receptor antagonist that blocks adenosine diphosphate-induced platelet activation and aggregation. Co-administered with acetylsalicylic acid, it is indicated for reducing thrombotic cardiovascular events in patients with coronary artery disease (CAD) undergoing PCI who have not received an oral P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) prior to PCI and in whom oral therapy is not feasible or desirable. Our purpose was to assess the economic consequences of incorporating cangrelor into the hospital formulary for the acute care of CAD patients undergoing PCI in Germany. A budget impact model (BIM) was developed. The 3-year pharmacological and clinical event costs of two hypothetical scenarios, without and with cangrelor for the primary PCI population in Germany were compared. Epidemiological, efficacy (stent thrombosis, myocardial infarction (MI), ischaemia-driven revascularization, death), safety (Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria) and costs (€, 2019) data were based on clinical trials, meta-analyses and on German registries. Only the costs of pre-treatment (pre-loading) with oral P2Y12 inhibitors and bail-out with glycoprotein IIb-IIIa inhibitors (GPI) were considered. One-way sensitivity analysis established the effect of uncertainty on BIM results. The model assumes that the three-year primary PCI population is 240,539 (85% are STEMI patients). The uptake of cangrelor changes from 0.40% to 0.90% in the same period. Considering current antithrombotics use and PCI management costs in Germany, the three-year budget impact of adding cangrelor into the hospital formulary for the primary PCI population represents less than 5 hundred thousand €. Results are most sensible to GPI bail-out use. Under BIM assumptions, introducing cangrelor for the acute care of CAD patients undergoing primary PCI represents a consistently affordable option in Germany. Cangrelor is particularly valuable when oral pre-treatment and adequate control of thrombosis cannot be guaranteed.