title: Cost-effectiveness analysis of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome in Colombia.
abstract: BACKGROUND
  Acute coronary syndrome is one of the most frequent medical emergencies in developing countries.
  
  
  OBJECTIVE
  To determine, from the perspective of the Colombian health system, the cost-effectiveness of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome.
  
  
  METHODS
  We conducted a cost-effectiveness analysis from the perspective of the Colombian health system comparing ticagrelor and clopidogrel for the treatment of patients with acute coronary syndrome. To estimate the expected costs and outcomes, a Markov model was constructed in which patients could remain stable without experiencing new cardiovascular events, suffer from a new event, or die. For the baseline case, a 10-year time horizon and a discount ratio of 3% for costs and benefits were adopted. The transition probabilities were extracted from the PLATO (Platelet Inhibition and Patient Outcomes) clinical trial. Vital statistics were drawn from the Departmento Administrativo Nacional de Estadística (DANE) and additional information from Colombian patients included in the Access registry. To identify and measure resource use, a standard case was built by consulting guidelines and protocols. Unit costs were obtained from Colombian rate lists. A probabilistic sensitivity analysis was conducted in which costs were represented by a triangular distribution, and the effectiveness through a beta distribution.
  
  
  RESULTS
  In the base case, the additional cost per quality-adjusted life-year gained with ticagrelor was COP$ 28,411,503. The results were sensitive to changes in the time horizon and the unit cost of clopidogrel. For a willingness-to-pay equivalent to three times the Colombian per capita gross domestic product, the probability of ticagrelor being cost-effective was 75%.
  
  
  CONCLUSIONS
  Ticagrelor is a cost-effective strategy for the treatment of patients with acute coronary syndrome in Colombia.
authors: Instituto de Evaluación Tecnológica en Salud, Bogotá, D.C, Colombia.
authors: Aurelio
authors: A
authors: Mejía
authors: Grupo de Rehabilitación en Salud, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors: Juan Manuel
authors: JM
authors: Senior
authors: Grupo de Economía de la Salud, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors: Mateo
authors: M
authors: Ceballos
authors: Grupo de Economía de la Salud, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors: Sara
authors: S
authors: Atehortúa
authors: Grupo Académico de Epidemiología Clínica, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors: Juan Manuel
authors: JM
authors: Toro
authors: Departamento de Cardiología Clínica y Cardiología Intervencionista, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors: Clara
authors: C
authors: Saldarriaga
authors: Grupo de Economía de la Salud, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors: María Elena
authors: ME
authors: Mejía
authors: Grupo de Economía de la Salud, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors: Carolina
authors: C
authors: Ramírez
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000191:economics*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D002648:Child; D000077144:Clopidogrel; D003105:Colombia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D011306:Prescription Fees / Q000706:statistics & numerical data; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin