title: Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy.
abstract: OBJECTIVE
  To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management.
  
  
  METHODS
  A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems.
  
  
  RESULTS
  Ticagrelor was associated with lifetime quality-adjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability.
  
  
  CONCLUSIONS
  Treatment of patients with ACS scheduled for 12 months' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel.
  
  
  BACKGROUND
  NCT000391872.
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Division of Health Care Analysis, Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-9375-5087
authors.initials: M
authors.lastname: Janzon
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: James
authors.affiliation: Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Cannon
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, UK.
authors.forename: R F
authors.initials: RF
authors.lastname: Storey
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Mellström
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: J C
authors.initials: JC
authors.lastname: Nicolau
authors.affiliation: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Wallentin
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Linköping, Sweden AstraZeneca Nordic-Baltic, Södertälje, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Henriksson
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D000241:Adenosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D001938:Brazil; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D019468:Disease Management; D004562:Electrocardiography; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D017063:Outcome Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention / Q000191:economics / Q000379:methods; D013548:Sweden; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: QUALITY OF CARE AND OUTCOMES