PCV69 COST EFFECTIVENESS ANALYSIS OF TICAGRELOR VERSUS CLOPIDOGREL IN STEMI PATIENTS FROM NATIONAL HEART INSTITUTE PERSPECTIVE IN EGYPT

Abstract

Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in Egypt. Early diagnosis and prompt, effective therapy are essential to reverse ischemia, restore normal coronary blood flow, and limit myocardial damage .The main objective is to compare costs and outcomes associated with the use of Ticagrelor versus Clopidogrel in patients with STEMI following PCI from NHI perspective in Egypt. A cost utility study is adopted, The model design adopted was a combination of one-year decision tree followed by a long-term Markov model to ensure that all major clinical and resource generating events that a patient may experience throughout the course of their remaining life are captured . The clinical evidence was taken from PLATO-STEMI sub study , acquisition cost of drugs, monitoring cost and cost associated with each health state is collected from NHI and MOH hospitals in financial fiscal year 2019. Utilities were captured from published studies for the same target population . A discount rate of 3.5% is used for both cost &QALY, DSA and PSA were conducted. Ticagrelor over 25 year time horizon provides an incremental health gain of 16.87 QALYs compared with Clopidogrel, at an incremental cost of 243,499 EGP resulting in an ICER of 14,433 EGP/QALY. The result was below the accepted willingness to pay threshold of Egypt which is equal 86000 EGP/QALY. The costs associated with the MI health state in the first year of clopidogrel arm had the great impact on the results of the study based on the results of DSA, the results of PSA revealed from the cost-effectiveness acceptability curve that at a willingness to pay of 86000EGP per QALY, the probability of Ticagrelor being cost-effective is 100%. Ticagrelor revealed to be a cost effective treatment option for STEMI patients following PCI compared to Clopidogrel intervention from NHI perspective in Egypt.