Cost-effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes in Canada.
BACKGROUND
Ticagrelor demonstrated a significant reduction in major cardiac events in patients with acute coronary syndrome (ACS) compared with clopidogrel in the Platelet Inhibition and Patient Outcomes (PLATO) trial. The objective of this study was to assess the cost-effectiveness of ticagrelor compared with clopidogrel in ACS patients from the perspective of the Canadian publicly funded health care system.


METHODS
A two-part model was developed consisting of a 1-year decision tree and a lifetime Markov model. Within the decision tree, patients remained event-free, experienced a nonfatal myocardial infarction, a nonfatal stroke, or death due to vascular or nonvascular related causes based on data from the PLATO trial. The lifetime Markov model followed these patients and allowed for subsequent myocardial infarction, stroke, and death. Patient utility and resource use were derived from the PLATO trial. Transition probabilities and specific Canadian unit costs were derived from published sources. Univariate and probabilistic sensitivity analyses were conducted.


RESULTS
In the base case lifetime analysis, treatment with ticagrelor resulted in more years of life per person (0.097), more quality-adjusted life years per person (QALYs, 0.084), and an incremental cost per QALY gained of $9,745 (Canadian$), assuming a generic cost for clopidogrel. A probabilistic sensitivity analysis demonstrated the robustness of the base case analysis, with a 93% probability of being below $20,000 per QALY gained and a 99% probability of being below $30,000 per QALY gained.


CONCLUSIONS
Ticagrelor is a clinically superior and cost-effective option for the prevention of thrombotic events among ACS patients in Canada.
Cornerstone Research Group, Burlington, ON, Canada.
Daniel T
DT
Grima
Cornerstone Research Group, Burlington, ON, Canada.
Stephen T
ST
Brown
AstraZeneca Canada, Mississauga, ON, Canada.
Laveena
L
Kamboj
Mazankowski Alberta Heart Institute/University of Alberta Hospital, Edmonton, AB, Canada.
Kevin R
KR
Bainey
Program for Assessment of Technology in Health, St Joseph's Hospital, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Ron
R
Goeree
University Health Network, Toronto, ON, Canada.
Paul
P
Oh
St Paul's Hospital, Vancouver, BC.
Krishnan
K
Ramanathan
St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Shaun G
SG
Goodman
acute coronary syndrome; antiplatelet therapy; clopidogrel; cost-effectiveness analysis; cost-utility analysis; percutaneous coronary intervention; ticagrelor