title: Prasugrel compared to clopidogrel in patients with acute coronary syndrome undergoing percutenaous coronary intervention: a Spanish model-based cost effectiveness analysis.
abstract: OBJECTIVE
  To assess the long-term cost-effectiveness of 12 months treatment of prasugrel compared to clopidogrel in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in the Spanish health care system.
  
  
  METHODS
  A Markov state transition model was developed to estimate health outcomes, quality adjusted life years (QALYs), life years (LY), and costs over patients' lifetimes. Clinical inputs were based on an analysis of the TRITON-TIMI 38 clinical trial. Hospital readmissions captured during the trial in a sub-study of patients from eight countries (and subsequent re-hospitalisations modelled to accrue beyond the time horizon of the trial), were assigned to Spanish diagnosis-related group payment schedules to estimate hospitalisation costs.
  
  
  RESULTS
  Mean total treatment costs were ?11,427 and ?10,910 for prasugrel and clopidogrel respectively. The mean cost of the study drug was ?538 higher for prasugrel vs. clopidogrel, but rehospitalisation costs at 12 months were ?79 lower for prasugrel due to reduced rates of revascularisation. Hospitalisation costs beyond 12 months were higher with prasugrel by ?55, due to longer life expectancy (+0.071 LY and +0.054 QALYs) associated with the decreased nonfatal myocardial infarction rate in the prasugrel group. The incremental cost per life year and QALY gained with prasugrel was ?7,198, and ?9,489, respectively.
  
  
  CONCLUSIONS
  Considering a willingness-to-pay threshold of ?30,000/QALY gained in the Spanish setting, prasugrel represents a cost-effective option in comparison with clopidogrel among patients with ACS undergoing PCI.
authors.forename: A
authors.initials: A
authors.lastname: Davies
authors.forename: M
authors.initials: M
authors.lastname: Sculpher
authors.forename: A
authors.initials: A
authors.lastname: Barrett
authors.forename: T
authors.initials: T
authors.lastname: Huete
authors.forename: J A
authors.initials: JA
authors.lastname: Sacristán
authors.forename: T
authors.initials: T
authors.lastname: Dilla
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D006328:Cardiac Catheterization / Q000191:economics; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D002986:Clinical Trials as Topic / Q000191:economics* / Q000706:statistics & numerical data; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000139:chemically induced / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D018803:Models, Economic; D015337:Multicenter Studies as Topic / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000191:economics; D010879:Piperazines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D013030:Spain; D013876:Thiophenes / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine