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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

Results of the probabilistic sensitivity analysis
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Fig3: Results of the probabilistic sensitivity analysis

Mentions: An overview of the results from the various scenarios explored with the model is provided in Fig. 2. The negative ICER shown for the sensitivity analysis regarding the price of branded clopidogrel is due to ticagrelor being cost-saving, i.e., dominating, in that sensitivity analysis. Sensitivity analysis for NSTEMI/UA and STEMI were not provided as the overall results have shown to be very stable (Fig. 3). The model has shown to be robust against changes in costs and clinical parameters. In particular, the variation in the price level of clopidogrel had a strong influence on the relative results. In order to evaluate the influence of generic substitution of clopidogrel hydrogenous sulfate with generic clopidogrel besilate and clopidogrel hydrochloride, a separate one-way sensitivity analysis used daily costs for clopidogrel of EUR 0.35. This resulted in incremental costs for ticagrelor of EUR 560 and an incremental cost-effectiveness ratio of EUR 3,118 per year of life gained. By contrast, ticagrelor becomes a dominant strategy when the branded price of clopidogrel is assumed.Fig. 2


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)

Results of the probabilistic sensitivity analysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Results of the probabilistic sensitivity analysis
Mentions: An overview of the results from the various scenarios explored with the model is provided in Fig. 2. The negative ICER shown for the sensitivity analysis regarding the price of branded clopidogrel is due to ticagrelor being cost-saving, i.e., dominating, in that sensitivity analysis. Sensitivity analysis for NSTEMI/UA and STEMI were not provided as the overall results have shown to be very stable (Fig. 3). The model has shown to be robust against changes in costs and clinical parameters. In particular, the variation in the price level of clopidogrel had a strong influence on the relative results. In order to evaluate the influence of generic substitution of clopidogrel hydrogenous sulfate with generic clopidogrel besilate and clopidogrel hydrochloride, a separate one-way sensitivity analysis used daily costs for clopidogrel of EUR 0.35. This resulted in incremental costs for ticagrelor of EUR 560 and an incremental cost-effectiveness ratio of EUR 3,118 per year of life gained. By contrast, ticagrelor becomes a dominant strategy when the branded price of clopidogrel is assumed.Fig. 2

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