Cost-Effectiveness of Ticagrelor for Acute Coronary Disease to Prevent Cardiovascular Events in Three Hospitals in Indonesia

Jarir At Thobari; Lucia Krisdinarti; Dhite Nugroho; Jonathan Haposan; Isman Firdaus; Rr. Arum Ramadhyan Suryandani; Muhammad Munawar; Jimmy Agung

doi:10.3889/oamjms.2022.9671

Authors

Jarir At Thobari Department of Pharmacology and Therapy, Division of Pharmacoepidemiology and Pharmacoeconomics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Lucia Krisdinarti Department of Cardiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Dhite Nugroho Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Jonathan Haposan Clinical Epidemiology and Biostatistics Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Isman Firdaus Department of Cardiology and Vascular Medicine, Harapan Kita Hospital, Jakarta, Indonesia
Rr. Arum Ramadhyan Suryandani Department of Cardiology and Vascular Medicine, Harapan Kita Hospital, Jakarta, Indonesia
Muhammad Munawar Cardiac Center, Bina Waluya Hospital, Jakarta, Indonesia
Jimmy Agung Cardiac Center, Bina Waluya Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9671

Keywords:

Ticagrelor, Cost-effectiveness, Acute coronary disease, Cost

Abstract

Background: Acute coronary syndromes (ACS) are life-threatening CVD associated with Indonesia's significant health and economic burdens. The study objective was to evaluate the cost-effectiveness of ticagrelor in reducing CV endpoint in the Indonesia setting.

Methods: Markov model was used as a decision analysis to compare ticagrelor with clopidogrel. We constructed decision tree model included four health conditions (no additional events, non-fatal myocardial infarction, non-fatal stroke, and any cause death), The probability of each state and quality-adjusted life years were derived from the PLATO trial and Indonesia life table. The outcome's resource consumption and associated costs were collected from three hospitals (public, national referral, and private hospitals) in Indonesia. The study used 5 years and lifetime horizon and discounting rate of 3%.

Results: The incremental QALYs and life-year gained (LYG) of ticagrelor in five years was 0.0410 and 0.0462, respectively; in a lifetime was 0.0828, and 0.0947, respectively. The ICER per QALY of ticagrelor versus clopidogrel in private, national referral, and public hospitals was USD 2390.276, USD 3813.638, USD 1278.361, respectively for five years; and USD 2471.392, USD 5453.987, USD 2343.269, respectively for a lifetime. The probability of ticagrelor to be cost-effective was about 66.6% on a five-year and 99.7% on a lifetime with WTP USD 3634.

Conclusion: Compared to the clopidogrel, QALYs and life-year gained of use ticagrelor higher. The incremental cost-effectiveness ratio in five years and lifetime model showed under one-time GDP, it means the use of ticagrelor was vastly cost-effective and acceptable to apply in the Indonesian clinical setting.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Kowalczyk M, Banach M, Mikhailidis DP, Hannam S, Rysz J. Ticagrelor--a new platelet aggregation inhibitor in patients with acute coronary syndromes. An improvement of other inhibitors? Med Sci Monit. 2009;15(12):Ms24-30. PMid:19946242

Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: The ONSET/OFFSET study. Circulation. 2009;120(25):2577-85. https://doi.org/10.1161/circulationaha.109.912550 PMid:19923168 DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.912550

Henriksson M, Nikolic E, Ohna A, Wallentin L, Janzon M. Ticagrelor treatment in acute coronary syndrome is cost-effective in Sweden and Denmark. Scand Cardiovasc J. 2014;48(3):138-47. https://doi.org/10.3109/14017431.2014.902494 PMid:24650118 DOI: https://doi.org/10.3109/14017431.2014.902494

Henriksson M, Janzon M. Cost-effectiveness of ticagrelor in acute coronary syndromes. J Expert Rev Pharmacoeconomics Outcomes Res. 2013;13(1):9-18. https://doi.org/10.1586/erp.12.89 DOI: https://doi.org/10.1586/erp.12.89

Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. J N Engl J Med. 2009;361(11):1045-57. https://doi.org/10.1056/nejmoa0904327 PMid:19717846 DOI: https://doi.org/10.1056/NEJMoa0904327

Kang HJ, Clare RM, Gao R, Held C, Himmelmann A, James SK, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the platelet inhibition and patient outcomes (PLATO) trial. Am Heart J. 2015;169(6):899-905.e1. https://doi.org/10.1016/j.ahj.2015.03.015 PMid:26027629 DOI: https://doi.org/10.1016/j.ahj.2015.03.015

Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: Alternative approaches. J Bull World Health Organ. 2014;93(2):118-24. https://doi.org/10.2471/blt.14.138206 PMid:25883405 DOI: https://doi.org/10.2471/BLT.14.138206

Nikolic E, Janzon M, Hauch O, Wallentin L, Henriksson M. Costeffectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: Results from the PLATO study. Eur Heart J. 2013;34(3):220-8. https://doi.org/10.1093/eurheartj/ehs149 PMid:22719022 DOI: https://doi.org/10.1093/eurheartj/ehs149

Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP. Long-term survival after first-ever stroke: The oxfordshire community stroke project. J Stroke. 1993;24(6):796-800. https://doi.org/10.1161/01.str.24.6.796 DOI: https://doi.org/10.1161/01.STR.24.6.796

Cowper PA, Pan W, Anstrom KJ, Kaul P, Wallentin L, Davidson-Ray L, et al. Economic analysis of ticagrelor therapy from a US perspective: Results from the PLATO study. J Am Coll Cardiol. 2015;65(5):465-76. https://doi.org/10.1016/j.jacc.2014.11.034 PMid:25660925 DOI: https://doi.org/10.1016/j.jacc.2014.11.034

Liew D, Lourenço RD, Adena M, Chim L, Aylward P. Costeffectiveness of 12-month treatment with ticagrelor compared with clopidogrel in managing acute coronary syndromes. J Clin Ther. 2013;35(8):1110-7.e9. https://doi.org/10.1016/j.clinthera.2013.06.015 PMid:23891361 DOI: https://doi.org/10.1016/j.clinthera.2013.06.015

Wu DB, Choon JW, Chong CW, Lee BS, Lee KK. Economic evaluation of ticagrelor in treating patients with acute coronary syndrome in Hong Kong: A Cost-Utility analysis. Int J Health Econ Policy. 2020;5(3):63-71. https://doi.org/10.11648/j.hep.20200503.13 DOI: https://doi.org/10.11648/j.hep.20200503.13

Chin CT, Mellstrom C, Chua T, Matchar DB. Lifetime costeffectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: A Singapore healthcare perspective. Singapore Med J. 2013;54(3):169-75. https://doi.org/10.11622/smedj.2013045 PMid:23546032 DOI: https://doi.org/10.11622/smedj.2013045

Wu B, Tobe RG, Liu Y, He B. Health economic analysis of antiplatelet therapy for acute coronary syndromes in the context of five eastern Asian countries. Clin Drug Invest. 2018;38(7):621-30. https://doi.org/10.1007/s40261-018-0649-x PMid:29713921 DOI: https://doi.org/10.1007/s40261-018-0649-x

Yamwong S, Permsuwan U, Tinmanee S, Sitara P. Long-term cost-effectiveness of ticagrelor in patients with acute coronary syndromes in Thailand. Health Econ Rev. 2014;4(1):17. https://doi.org/10.1186/s13561-014-0017-3 PMid:26208920 DOI: https://doi.org/10.1186/s13561-014-0017-3

Fanari Z, Weiss S, Weintraub WS. Cost-effectiveness of antiplatelet and antithrombotic therapy in the setting of the acute coronary syndrome: Current perspective and literature review. Am J Cardiovasc Drugs. 2015;15(6):415-27. https://doi.org/10.1007/s40256-015-0131-6 PMid:26068886 DOI: https://doi.org/10.1007/s40256-015-0131-6

Gasche D, Ulle T, Meier B, Greiner RA. Cost-effectiveness of ticagrelor and generic clopidogrel in patients with the acute coronary syndrome in Switzerland. Swiss Med Wkly. 2013;143:w13851. https://doi.org/10.4414/smw.2013.13851 PMid:24089294 DOI: https://doi.org/10.4414/smw.2013.13851

Theidel U, Asseburg C, Giannitsis E, Katus H. Cost-effectiveness of ticagrelor versus clopidogrel for preventing atherothrombotic events in adult patients with the acute coronary syndrome in Germany. Clin Res Cardiol. 2013;102(6):447-58. https://doi.org/10.1007/s00392-013-0552-7 PMid:23474908 DOI: https://doi.org/10.1007/s00392-013-0552-7

Grima DT, Brown ST, Kamboj L, Bainey KR, Goeree R, Oh P, et al. Cost-effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes in Canada. Clinicoecon Outcomes Res. 2014;6:49-62. https://doi.org/10.2147/ceor.s51052 PMid:24493930 DOI: https://doi.org/10.2147/CEOR.S51052

Steg P, Bhatt DL, James SK, Darlington O, Hoskin L, Simon T, et al. Cost-effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease with a history of PCI: An economic evaluation of THEMIS-PCI using a Swedish healthcare perspective. Eur Heart J. 2020;41(Suppl_2):ehaa946-3538. https://doi.org/10.1093/ehjci/ehaa946.3538 DOI: https://doi.org/10.1093/ehjci/ehaa946.3538

Berwanger O, Lopes RD, Moia DDF, Fonseca FA, Jiang L, Goodman SG, et al. Ticagrelor versus clopidogrel in patients with stemi treated with fibrinolysis: TREAT trial. J Am Coll Cardiol. 2019;73(22):2819-28. https://doi.org/10.1016/j.jacc.2019.03.011 PMid:30898608 DOI: https://doi.org/10.1016/j.jacc.2019.03.011

Schuetz CA, Ong SH, Bluher M. Clinical trial simulation methods for estimating the impact of DPP-4 inhibitors on cardiovascular disease. Clinicoecon Outcomes Res. 2015;7:313-23. https://doi.org/10.2147/ceor.s75935 PMid:26089691 DOI: https://doi.org/10.2147/CEOR.S75935

Coleman CI, Limone BL. Cost-effectiveness of universal and platelet reactivity assay-driven antiplatelet therapy in acute coronary syndrome. Am J Cardiol. 2013;112(3):355-62. https://doi.org/10.1016/j.amjcard.2013.03.036 PMid:23631863 DOI: https://doi.org/10.1016/j.amjcard.2013.03.036

Capodanno D, Buccheri S, Romano S, Capranzano P, Francaviglia B, Tamburino C. Decision analytic markov model weighting expected benefits and current limitations of firstgeneration bioresorbable vascular scaffolds: Implications for manufacturers and next device iterations. Circ Cardiovasc Interv. 2018;11(1):e005768. https://doi.org/10.1161/circinterventions.117.005768 DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.117.005768