PCV52 Cost Analysis on Prasugrel/Ticagrelor Versus Clopidogrel As PART of Dapt in Hong Kong Post-ACS Patients

Abstract

Clinical benefit of prasugrel or ticagrelor over clopidogrel as part of dual antiplatelet therapy (DAPT) was inconclusive in Asian population. The study aimed to compare the direct medical cost of using prasugrel/ticagrelor versus clopidogrel as part of DAPT in Hong Kong acute coronary syndrome (ACS) patients. The retrospective observational cohort study included patients, aged 18 years old or above, admitted to seven institutions under Hospital Authority Hong Kong with diagnosis of ACS during 2008-2017. Cost analysis was conducted to evaluate direct medical cost related to ACS management using prasugrel/ticagrelor versus clopidogrel as part of DAPT at one year, two years and five years post-ACS episode. Cost of drugs, cost of hospitalization and procedures, as well as cost of cardiovascular (CV)-related clinic visit were considered. Association of cost difference and choice of P2Y12 receptor antagonist was investigated using adjusted linear regression or adjusted Poisson regression model. A total number of 7349, 6079 and 3611 ACS patients were included for one-year, two-year and five-year analyses respectively. Compared to clopidogrel, prasugrel/ticagrelor was associated with lower cost of hospitalization at one-year and two-year analysis, lower cost of CV-related clinic visit at one-year, two-year and five-year analysis and higher cost of drug at one-year, two-year and five-year analysis. Despite higher cost of drug, prasugrel/ticagrelor was associated with lower cost of CV-related clinic visit in five years and lower cost of hospitalization in two years after index event.