PCV40 COST-EFFECTIVENESS ANALYSIS OF PRASUGREL, CLOPIDOGREL AND TICAGRELOR IN DUAL ANTIPLATELET THERAPY ON PATIENTS WITH ACUTE CORONARY SYNDROME IN AUSTRIA BETWEEN 2009 AND 2014

Abstract

We have conducted a cost-effectiveness analysis to evaluate the cost-effectiveness of the compared therapies with P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor). The number of treated patients was 32830. 18640 (56.8%) of them were prescribed clopidogrel, 6683 (20.4%) of them prasugrel, and (7507) 22.9% of them ticagrelor. The primary end point was recurrence of ACS or death >30 day after the index event. Data was collected from an observational study – a comprehensive population study in Austria between 2009 and 2014 including data from 13 Austrian health insurance funds. The cumulative incidence of ACS/death was used as a measure for the therapeutic results. The results from the cost-effectiveness analysis show that the incremental cost-effectiveness ratio (ICER) for prasugrel compared to clopidogrel is 874.86 EUR, for ticagrelor compared to clopidogrel is 753.99 EUR. The cost-effectiveness ratio for clopidogrel itself is 2719.32 EUR. This means prasugrel/ticagrelor is cost-effective over clopidogrel in terms of additional cost to be paid for patients with cumulative incidence of ACS/death. Furthermore, our study has shown that ticagrelor has a better ICER compared to prasugrel when clopidogrel was used as an active comparator in terms of additional cost that should be paid for additional cases of ACS or death. A sensitivity analysis was also conducted to measure the effect of the uncertain data (cost of therapy and results measured in HR) on the ICER. Our sensitivity analysis has shown that the parameter that influences the changes in the ICER the most is the cost of ticagrelor, followed by the efficacy and cost of prasugrel. Overall ticagrelor is the most cost-effective agent within the dual antiplatelet therapy (DAPT).