COST-EFFECTIVENESS ANALYSIS OF TICAGRELOR IN ACUTE CORONARY SYNDROME PATIENTS IN COLOMBIA

Background: Ticagrelor is an oral, reversibly binding, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12, indicated for the reduction of clinical thrombotic events in patients with acute coronary syndrome (ACS), and has a more rapid onset and more pronounced platelet inhibition than Clopidogrel. In the PLATO Phase III study, ticagrelor +ASA significantly reduced the rate of the composite endpoint of MI, stroke, or death from vascular causes, as compared Clopidogrel + ASA.

Purpose: This study evaluates the 5 years and life time cost effectiveness of treating acute coronary syndrome (ACS) patients with ticagrelor + ASA versus branded Clopidogrel + ASA.

Method: A two part cost-effectiveness model, comprising of a short term decision tree (utilizing the 12 months of data on costs and outcomes from PLATO), and a long term Markov model was utilized to estimate longer term costs and outcomes. Time horizons of 5 years and lifetime were used. Event rates and health care costs during the 12 months of therapy were calculated  from PLATO. The outcome studied was the life years gained (LYs); the Colombian costs were estimated in 2010 dollars and an annual discounted rate of 3% was applied to the costs and outcomes. A univariate sensitivity analysis was made to determine the sensitivity of results to changes in the price (+-20%) of ticagrelor and clopidogrel, also a multivariate sensibility analysis was made to determine the model´s robustness.

Result: At 5 years and life time horizon ticagrelor resulted in 0,0502 and 0,14 additional LYs, driven by the mortality benefit observed in PLATO. The total cost is lower than branded Clopidogrel (-$180 and -$162) at 5 years and life time horizon, respectively. The univariate sensitivity analysis shows that a lower total cost in the Ticagrelor arm with an improvement in the LYs makes ticagrelor a dominant treatment choice over clopidogrel, and an increase in the total costs in the ticagreolor arm compared to the clopidogrel arm makes  ticagrelor a cost effective therapy. Multivariate sensitivity analyses showed that the obtained result was robust to changes in key input parameters.

Conclusion: In patients with acute coronary syndrome ticagrelor is a dominant therapy over branded clopidogrel with lower costs and improved LYGs, at 5 years and life time horizon.