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Cost-effectiveness of ticagrelor versus clopidogrel for the prevention of atherothrombotic events in adult patients with acute coronary syndrome in Germany.

Theidel U, Asseburg C, Giannitsis E, Katus H - Clin Res Cardiol (2013)

Bottom Line: The aim of this health economic analysis was to compare the cost-effectiveness of ticagrelor versus clopidogrel within the German health care system.The incremental cost-effectiveness ratio (ICER) was EUR 2,385 per LYG (EUR 2,728 per QALY).Hence, 12 months of ACS treatment using ticagrelor/ASA instead of clopidogrel/ASA may offer a cost-effective therapeutic option, even when the generic price for clopidogrel is employed.

View Article: PubMed Central - PubMed

Affiliation: Herescon Gmbh, Königsworther Str. 2 30167 Hannover, Germany. theidel@herescon.com [corrected]

ABSTRACT
The aim of this health economic analysis was to compare the cost-effectiveness of ticagrelor versus clopidogrel within the German health care system. A two-part decision model was adapted to compare treatment with ticagrelor or clopidogrel in a low-dose acetylsalicylic acid (ASA) cohort (≤150 mg) for all ACS patients and subtypes NSTEMI/IA and STEMI. A decision-tree approach was chosen for the first year after initial hospitalization based on trial observations from a subgroup of the PLATO study. Subsequent years were estimated by a Markov model. Following a macro-costing approach, costs were based on official tariffs and published literature. Extensive sensitivity analyses were performed to test the robustness of the model. One-year treatment with ticagrelor is associated with an estimated 0.1796 life-years gained (LYG) and gained 0.1570 quality-adjusted life-years (QALY), respectively, over the lifetime horizon. Overall average cost with ticagrelor is estimated to be EUR 11,815 vs. EUR 11,387 with generic clopidogrel over a lifetime horizon. The incremental cost-effectiveness ratio (ICER) was EUR 2,385 per LYG (EUR 2,728 per QALY). Comparing ticagrelor with Plavix(®) or the lowest priced generic clopidogrel, ICER ranges from dominant to EUR 3,118 per LYG (EUR 3,567 per QALY). These findings are robust under various additional sensitivity analyses. Hence, 12 months of ACS treatment using ticagrelor/ASA instead of clopidogrel/ASA may offer a cost-effective therapeutic option, even when the generic price for clopidogrel is employed.

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Related in: MedlinePlus

Model structure used for all subgroup analyses
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Fig1: Model structure used for all subgroup analyses

Mentions: Treatment with ticagrelor or clopidogrel is recommended only for 12 months. Therefore, the patients receive the drug therapy in both arms only in the first year. In the second step for the long-term analysis, a Markov model approach was chosen with a cycle length of 12 months. As no long-term data are available after the first year of treatment, the conservative assumption was made that no relevant differences exist regarding the efficacy between both alternatives. Starting the model with the Markov approach with the second year the only difference between both model arms arises from the different distribution of patients in the different Markov states after the first year. Moreover, transition probabilities of clinical events are assumed to be independent of treatment arm in the long-term model; Fig. 1 shows the model schematically.Fig. 1


Cost-effectiveness of ticagrelor versus clopidogrel for the prevention of atherothrombotic events in adult patients with acute coronary syndrome in Germany.

Theidel U, Asseburg C, Giannitsis E, Katus H - Clin Res Cardiol (2013)

Model structure used for all subgroup analyses
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269206&req=5

Fig1: Model structure used for all subgroup analyses
Mentions: Treatment with ticagrelor or clopidogrel is recommended only for 12 months. Therefore, the patients receive the drug therapy in both arms only in the first year. In the second step for the long-term analysis, a Markov model approach was chosen with a cycle length of 12 months. As no long-term data are available after the first year of treatment, the conservative assumption was made that no relevant differences exist regarding the efficacy between both alternatives. Starting the model with the Markov approach with the second year the only difference between both model arms arises from the different distribution of patients in the different Markov states after the first year. Moreover, transition probabilities of clinical events are assumed to be independent of treatment arm in the long-term model; Fig. 1 shows the model schematically.Fig. 1

Bottom Line: The aim of this health economic analysis was to compare the cost-effectiveness of ticagrelor versus clopidogrel within the German health care system.The incremental cost-effectiveness ratio (ICER) was EUR 2,385 per LYG (EUR 2,728 per QALY).Hence, 12 months of ACS treatment using ticagrelor/ASA instead of clopidogrel/ASA may offer a cost-effective therapeutic option, even when the generic price for clopidogrel is employed.

View Article: PubMed Central - PubMed

Affiliation: Herescon Gmbh, Königsworther Str. 2 30167 Hannover, Germany. theidel@herescon.com [corrected]

ABSTRACT
The aim of this health economic analysis was to compare the cost-effectiveness of ticagrelor versus clopidogrel within the German health care system. A two-part decision model was adapted to compare treatment with ticagrelor or clopidogrel in a low-dose acetylsalicylic acid (ASA) cohort (≤150 mg) for all ACS patients and subtypes NSTEMI/IA and STEMI. A decision-tree approach was chosen for the first year after initial hospitalization based on trial observations from a subgroup of the PLATO study. Subsequent years were estimated by a Markov model. Following a macro-costing approach, costs were based on official tariffs and published literature. Extensive sensitivity analyses were performed to test the robustness of the model. One-year treatment with ticagrelor is associated with an estimated 0.1796 life-years gained (LYG) and gained 0.1570 quality-adjusted life-years (QALY), respectively, over the lifetime horizon. Overall average cost with ticagrelor is estimated to be EUR 11,815 vs. EUR 11,387 with generic clopidogrel over a lifetime horizon. The incremental cost-effectiveness ratio (ICER) was EUR 2,385 per LYG (EUR 2,728 per QALY). Comparing ticagrelor with Plavix(®) or the lowest priced generic clopidogrel, ICER ranges from dominant to EUR 3,118 per LYG (EUR 3,567 per QALY). These findings are robust under various additional sensitivity analyses. Hence, 12 months of ACS treatment using ticagrelor/ASA instead of clopidogrel/ASA may offer a cost-effective therapeutic option, even when the generic price for clopidogrel is employed.

Show MeSH
Related in: MedlinePlus