PCV8 - Cost-Utility Of Prasugrel Compared To Clopidogrel For Preventing Cardiovascular Events In Diabetic Patients With Acute Coronary Syndrome In Brazil

Abstract

To assess the cost-utility of prasugrel in diabetic patients with acute coronary syndrome, from both private and public payer´s perspective. An event-based Markov cohort model was built in Microsoft Excel. The 62-year old cohort could receive clopidogrel 75 mg tablets or prasugrel 10 mg tablets. Independently of the administered drug, each patient was assumed to receive a loading dose followed by daily doses of one tablet for the rest of the treatment period, which was one year. After entering the model, the patients could have fatal or non-fatal myocardial infarction, stroke or major bleeding. The analysis was divided in three phases: one consisted of the first three treatment days, the second cycle consisted of the remaining period until the end of the first year, and the third phase was a lifetime period, with yearly cycles. The first two phases’ event probabilities were obtained in the pivotal TRITON-TIMI 38 clinical trial. The third phase’s event probabilities were based on extrapolations published in the study developed by the British NHS. Drug prices were obtained through search in the Health Prices Database (BPS) and in the drug prices regulator (CMED) database for the public and private sectors, respectively. Event costs were gathered from the Brazilian public claim databases (DataSUS) for the public payer and from the literature for the private payer perspective. Quality of life values were obtained through literature search. Probabilistic sensitivity analysis (PSA) were performed. The incremental cost-utility ratios (ICUR) were BRL 13.8 thousand and BRL 8.7 thousand per QALY gained from the public and private payer´s perspective, respectively. Prasugrel’s ICUR had more than 85% probability of being lower than one per capita GDP in both analysis. Assuming a three per capita GDP willingness-to-pay threshold, prasugrel may be considered very cost-effective.