title: One-year post-discharge resource utilization and treatment patterns of patients with acute coronary syndrome managed with percutaneous coronary intervention and treated with ticagrelor or prasugrel.
abstract: OBJECTIVE
  Our objective was to compare 1-year real-world healthcare resource utilization (HRU), associated charges, and antiplatelet treatment patterns among patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with ticagrelor or prasugrel.
  
  
  METHODS
  Using the ProMetis-Lx database, adult ACS-PCI patients treated with ticagrelor or prasugrel post-discharge were identified between 1 August 2011 and 31 May 2013 and propensity matched to adjust for baseline differences.
  
  
  RESULTS
  Before matching, ticagrelor-treated patients (n = 2991) were older with increased baseline ischemic and bleeding risks compared with prasugrel-treated patients (n = 12,797). After matching, ticagrelor patients had higher all-cause HRU (2.5 vs. 2.4 per patient per month; P = 0.012) and cardiovascular (CV) HRU (0.4 vs. 0.3 per patient per month; P = 0.026), with the difference in CV rehospitalizations (17.7 vs. 15.7 %; P = 0.011) primarily driven by congestive heart failure (CHF) (4.9 vs. 3.8 %; P = 0.02). All-cause charges within 1 year did not significantly differ between groups ($US5456 vs. 4844 per patient per month; P = 0.37), but dyspnea-related total charges were significantly higher with ticagrelor ($US139 vs. 95 per patient per month; P = 0.005). Although infrequent, switching was slightly higher with ticagrelor (8.3 vs. 6.0 %; P < 0.001) at 1 year, and mean persistence was slightly longer with prasugrel (150 vs. 159 days; P = 0.002), with no significant difference in mean adherence (61 vs. 63 %; P = 0.17).
  
  
  CONCLUSIONS
  Overall monthly HRU was slightly lower with prasugrel than with ticagrelor, with no significant difference in bleeding HRU. Prasugrel was associated with slightly higher pharmacy charges, but lower dyspnea charges, resulting in no significant difference in total charges. Patients receiving prasugrel tended to use it for longer than those receiving ticagrelor as less switching occurred. These findings may aid decision making, but must be tempered due to inherent study limitations.
authors.affiliation: Retrospective Observational Studies, Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Simeone
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA. molife_cliff@lilly.com.
authors.forename: Cliff
authors.initials: C
authors.lastname: Molife
authors.affiliation: Daiichi Sankyo Inc., Parsippany, NJ, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Marrett
authors.affiliation: Daiichi Sankyo Inc., Parsippany, NJ, USA.
authors.forename: Feride
authors.initials: F
authors.lastname: Frech-Tamas
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Effron
authors.affiliation: Retrospective Observational Studies, Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA.
authors.forename: Beth L
authors.initials: BL
authors.lastname: Nordstrom
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
authors.forename: Yajun E
authors.initials: YE
authors.lastname: Zhu
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Keller
authors.affiliation: Retrospective Observational Studies, Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Murphy
authors.affiliation: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
authors.affiliation: Allied Health Professions School, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: George W
authors.initials: GW
authors.lastname: Vetrovec
authors.affiliation: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: McCollam
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077486:Ticagrelor
chemical_list: D000925:Anticoagulants; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine