PCV45 Long Term Cost-Effectiveness Analysis of Ticagrelor in Patients with Acute Coronary Syndromes From a Turkish Health Care Perspective Based on Data From the Plato Trial

Abstract

The PLATO trial showed that in patients with acute coronary syndromes (ACS) treatment with ticagrelor compared with clopidogrel significantly reduced the rate of myocardial infarction, stroke, or death from vascular causes without a significant increase in the rate of overall major bleeding. The aim of this analysis is to estimate long-term cost-effectiveness of treating ACS patients with ticagrelor from a Turkish health care perspective. A two-part decision-analytic model, including a one-year decision tree and a long-term Markov model, was constructed to estimate lifetime costs, LYGs and QALYs of treating patients for one year with ticagrelor plus acetylsalicylic acid (ASA) compared with clopidogrel plus ASA. Event rates, health-care costs, and QALYs were estimated for the first year by using individual-patient data from PLATO. The cost was calculated by applying Turkish unit costs. For the second year onwards, necessary assumptions and external data sources were utilized to extrapolate quality-adjusted survival conditional on whether a non-fatal MI, a non-fatal stroke or no event occurred during the first year. Probabilistic ssensitivity analyses were performed. The willingness to pay threshold per QALY considered for the cost effectiveness analysis was 3 times GDP per capita. Ticagrelor was associated with life expectancy gains of 0.116 years primarily due to reduced rate of CV mortality and 0.101 additional QALYs and an incremental cost of 1662 TL compared to clopidogrel over a life time horizon.The incremental cost per life year and QALY gained were 14 297 TL and 16 415 TL respectively compared to clopidogrel. Probabilistic sensitivity analysis indicated > 99% probability of ticagrelor being cost-effective compared with clopidogrel at a willingness to pay of 52002 TL per QALY. Treating ACS patients with ticagrelor instead of clopidogrel for one year is cost-effective from the Turkish public health care perspective.