title: Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective.
abstract: BACKGROUND
  Ticagrelor is a novel antiplatelet drug developed to reduce atherothrombosis. The PLATO trial compared ticagrelor and aspirin to clopidogrel and aspirin in patients with acute coronary syndromes (ACS). Ticagrelor was found to be superior in the primary composite endpoint of cardiovascular death, myocardial infarction or stroke, without increasing major bleeding events. The current study estimates the lifetime cost-effectiveness of ticagrelor relative to generic clopidogrel from a Singapore public healthcare perspective.
  
  
  METHODS
  This study used a two-part cost-effectiveness model. The first part was a 12-month decision tree (using PLATO trial data) to estimate the rates of major cardiovascular events, healthcare costs and health-related quality of life. The second part was a Markov model estimating lifetime quality-adjusted survival and costs conditional on events during the initial 12 months. Daily drug costs applied were SGD 1.05 (generic clopidogrel) and SGD 6.00 (ticagrelor). Cost per quality-adjusted life years (QALY) was estimated from a Singapore public healthcare perspective using life tables and short-term costs from Singapore, and long-term costs from South Korea. Deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Ticagrelor was associated with a lifetime QALY gain of 0.13, primarily driven by lower mortality. The resulting incremental cost per QALY gained was SGD 10,136.00. Probabilistic sensitivity analysis indicated that ticagrelor had a > 99% probability of being cost-effective, given the lower recommended WHO willingness-to-pay threshold of one GDP/capita per QALY.
  
  
  CONCLUSIONS
  Based on PLATO trial data, one-year treatment with ticagrelor versus generic clopidogrel in patients with ACS, relative to WHO reference standards, is cost-effective from a Singapore public healthcare perspective.
authors.affiliation: Department of Cardiology, National Heart Centre Singapore, Mistri Wing, 17 Third Hospital Avenue, Singapore. chin.chee.tang@nhcs.com.sg
authors.forename: Chee Tang
authors.initials: CT
authors.lastname: Chin
authors.forename: Carl
authors.initials: C
authors.lastname: Mellstrom
authors.forename: Terrance Siang Jin
authors.initials: TS
authors.lastname: Chua
authors.forename: David Bruce
authors.initials: DB
authors.lastname: Matchar
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs; D006801:Humans; D008390:Markov Chains; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000191:economics; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000191:economics; D019057:Quality-Adjusted Life Years; D056910:Republic of Korea; D012846:Singapore; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin