Cost-effectiveness of antiplatelet drugs after percutaneous coronary intervention

European Heart Journal. Quality of Care & Clinical Outcomes
Torbjørn Wisløff, Dan Atar

Abstract

Clopidogrel has, for long time, been accepted as the standard treatment for patients who have undergone a percutaneous coronary intervention (PCI). The introduction of prasugrel-and more recently, ticagrelor-has introduced a decision-making problem for clinicians and governments worldwide: to use the cheaper clopidogrel or the more effective, and also more expensive prasugrel or ticagrelor. We aim to give helpful contributions to this debate by analysing the cost-effectiveness of clopidogrel, prasugrel, and ticagrelor compared with each other. We modified a previously developed Markov model of cardiac disease progression. In the model, we followed up cohorts of patients who have recently had a PCI until 100 years or death. Possible events are revascularization, bleeding, acute myocardial infarction, and death. Our analysis shows that ticagrelor is cost-effective in 77% of simulations at an incremental cost-effectiveness ratio of €7700 compared with clopidogrel. Ticagrelor was also cost-effective against prasugrel at a cost-effectiveness ratio of €7800. Given a Norwegian cost-effectiveness threshold of €70 000, both comparisons appear to be clearly cost-effective in favour of ticagrelor. Ticagrelor is cost-effective compared wit...Continue Reading

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Citations

Nov 11, 2017·European Heart Journal. Quality of Care & Clinical Outcomes·Sotiris AntoniouDaniel A Jones
Jan 5, 2019·Circulation. Cardiovascular Quality and Outcomes·Usman BaberRoxana Mehran
Jun 24, 2018·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·R J de Winter

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Methods Mentioned

BETA
coronary artery bypass

Software Mentioned

SMDM
MOCCA Model Of Cost
ISPOR

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