title: Economic analysis of ticagrelor therapy from a U.S. perspective: results from the PLATO study.
abstract: BACKGROUND
  Based on results of the PLATO (Platelet Inhibition and Patient Outcomes) trial comparing ticagrelor with clopidogrel therapy, the U.S. Food and Drug Administration approved ticagrelor in 2011 for reducing thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) with the proviso that it be taken with low-dose aspirin.
  
  
  OBJECTIVE
  This study sought to assess the cost and cost effectiveness of ticagrelor therapy relative to clopidogrel in treating ACS patients from the perspective of the U.S. health care system.
  
  
  METHODS
  We estimated within-trial resource use and costs using U.S. low-dose aspirin patients in PLATO (n = 547). Quality-adjusted life expectancy was estimated using the total PLATO population (n = 18,624), combined with baseline risk and long-term survival data from an external ACS patient cohort. Study drugs were valued at current costs. Cost effectiveness was assessed, as was the sensitivity of results to sampling and methodological uncertainties.
  
  
  RESULTS
  One year of ticagrelor therapy, relative to that of generic clopidogrel, cost $29,665/quality-adjusted life-year gained, with 99% of bootstrap estimates falling under a $100,000 willingness-to-pay threshold. Results were robust to extensive sensitivity analyses, including variations in clopidogrel cost, exclusion of costs in extended years of life, and a recalibrated estimate of survival reflecting a lower underlying mortality risk in the United States.
  
  
  CONCLUSIONS
  For PLATO-eligible ACS patients, a U.S. perspective comparison of the current standard of dual antiplatelet therapy of aspirin with clopidogrel versus aspirin plus ticagrelor showed that the ticagrelor regimen increased life expectancy at an incremental cost well within accepted benchmarks of good value for money. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872).
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: patricia.cowper@dm.duke.edu.
authors: Patricia A
authors: PA
authors: Cowper
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Wenqin
authors: W
authors: Pan
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Kevin J
authors: KJ
authors: Anstrom
authors: Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Padma
authors: P
authors: Kaul
authors: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors: Lars
authors: L
authors: Wallentin
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Linda
authors: L
authors: Davidson-Ray
authors: Center for Medical Technology Assessment and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors: Elisabet
authors: E
authors: Nikolic
authors: Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors: Magnus
authors: M
authors: Janzon
authors: Center for Medical Technology Assessment and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors: Lars-Åke
authors: LÅ
authors: Levin
authors: Thrombolysis In Myocardial Infarction Study Group, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Christopher P
authors: CP
authors: Cannon
authors: Department of Medicine, Stanford University, Stanford, California.
authors: Robert A
authors: RA
authors: Harrington
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Daniel B
authors: DB
authors: Mark
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000191:economics* / Q000401:mortality*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D000077144:Clopidogrel; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D015996:Survival Rate / Q000639:trends; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: acute coronary syndrome(s); antiplatelet therapy; clopidogrel; cost effectiveness; ticagrelor