Purpose: To analyze the cost-effectiveness of prasugrel compared to clopidogrel for patients who have undergone PCI (percutaneous coronary intervention) for acute coronary syndrome (ACS).
Method: We used a modified version of a Markov model (Model of cost-effectiveness of coronary artery disease (MOCCA)) previously developed by the Norwegian Knowledge Centre for the Health Services, to model the cost-effectiveness of prasugrel compared to clopidogrel. Possible events in the model were urgent target vessel revascularization (UTVR), myocardial infarction, bleeding and death. Incidences of events were based on Scandinavian registries. Costs of prasugrel and clopidogrel were based on list prices from the Norwegian Medicines Agency. Estimates of clinical efficacy were based on pooling of published RCTs. The model is built as a probabilistic model, hence, results are based on Monte Carlo simulations.
Result: Our modeling resulted in an increase in both life expectancy and costs with prasugrel. This gave an incremental cost-effectiveness ratio of $ 6,200 per life year gained for prasugrel compared with clopidogrel. The probabilistic sensitivity analyses demonstrated that prasugrel is cost-effective in 88% of the simulations. From our value of information analysis, it became evident that the decision depends mostly on the uncertainty in data on efficacy, and hence if new research should be conducted, this is the kind of data that has the highest potential to reduce decision uncertainty.
Conclusion: Prasugrel is likely to be more cost-effective than clopidogrel for ACS patients who have undergone PCI. This conclusion is, however, uncertain, and even for high levels of willingness to pay for health, there is some probability of clopidogrel being cost-effective.
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