title: Economic evaluation of ticagrelor for secondary prevention following acute coronary syndromes.
abstract: OBJECTIVE
  To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting.
  
  
  METHODS
  A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature.
  
  
  RESULTS
  Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of €610. Thus the incremental cost per life year saved is €4780 and the incremental cost per QALY is €5517.
  
  
  CONCLUSIONS
  The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.
authors.affiliation: Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisboa, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gouveia
authors.affiliation: Unidade de Farmacologia Clínica, Centro Hospitalar de Lisboa Central EPE & Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Borges
authors.affiliation: Corporate Affairs & Market Access Department, AstraZeneca - Produtos Farmacêuticos, Lda., Lisboa, Portugal. Electronic address: rosario.trindade@astrazeneca.com.
authors.forename: Rosário
authors.initials: R
authors.lastname: Trindade
authors.affiliation: Global Clinical Development Department, AstraZeneca, Mölndal, Suécia.
authors.forename: Klas
authors.initials: K
authors.lastname: Rikner
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000191:economics*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D006801:Humans; D058921:Purinergic P2Y Receptor Antagonists / Q000191:economics* / Q000627:therapeutic use; D055502:Secondary Prevention; D000077486:Ticagrelor
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077486:Ticagrelor; D000241:Adenosine
keywords: Acute coronary syndromes; Bypass aortocoronário com enxerto; Clopidogrel; Coronary artery bypass grafting; Cost‐effectiveness; Cost‐utility; Custo‐efetividade; Custo‐utilidade; Enfarte do miocárdio com elevação ST; Enfarte do miocárdio sem elevação ST; Intervenção coronária percutânea; Non‐ST‐elevation myocardial infarction; Percutaneous coronary intervention; ST‐elevation myocardial infarction; Síndroma coronária aguda; Síndromas coronárias agudas; Ticagrelor