PharmacoEconomics & Outcomes News 784, p28 - 12 Aug 2017 Ticagrelor cost effective in high risk subgroups? Dual antiplatelet therapy with ticagrelor and low-dose aspirin one to three years after myocardial infarction (MI) may be cost effective in high-risk subgroups, according to findings of a cost-utility substudy of the PEGASUS-TIMI 54 trial published in the Journal of the American College of Cardiology. The prospective, randomised PEGASUS-TIMI 54 trial in a total of 21 162 patients after MI showed that ticagrelor 90 or 60 mg/day and low-dose aspirin improved cardiovascular outcomes compared with aspirin alone. An in-trial analysis in 14 111 patients compared the cost effectiveness of ticagrelor 60mg twice daily or placebo, in addition to aspirin, from the perspective of the US healthcare system over a median follow-up period of 33 months. Investigators also used a Markov model to evaluate the long-term cost effectiveness of ticagrelor 60mg twice daily versus placebo, from a modified societal perspective over a lifetime time horizon. In the in-trial analysis, there was no significant difference in hospitalisation costs between ticagrelor ** vs $2333) and the QALY gain was and placebo ($2262 similar (2.28 vs 2.27) but total costs were higher with ticagrelor ($10 016 vs $2333; p<0.001) due to the drug cost ($10.52 per day). Over a lifetime, ticagrelor was estimated to achieve an incremental gain of 0.078 QALYs compared with placebo at an incremental cost of $7435, resulting in an estimated incremental cost-effectiveness ratio (ICER) of $94 917 per QALY gained. However, ICERs were lower in high-risk patients including those with two or more previous MIs, multivessel disease, diabetes mellitus or renal impairment ($50 000–$70 000 per QALY gained), aged under 75 years ($44 779 per QALY gained), or with peripheral artery disease ($13 427 per QALY gained). "Compared with aspirin alone, addition of ticagrelor in patients with a history of MI >1 year previously is associated with a cost-effectiveness ratio suggesting intermediate value. Ticagrelor has greater value for higher-risk patients," the investigators concluded. "Based on the results of the current study, from a cost- effective perspective, it appears reasonable to continue ticagrelor beyond 1 year in the patients with only the highest ischemic risk. These findings highlight the importance of careful scrutiny of eligibility as applied to individual patients in routine practice," commented Drs Eliano Navarese from Inova Heart and Vascular Institute, Falls Church, Virginia, and Jan Tijssen, from Academic Medical Center-University of Amsterdam, Naarden, the Netherlands, in accompanying editorial published in the Journal of the American College of Cardiology. * Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction 54 ** 2016 US dollars 1. Magnuson EA, et al. Cost-Effectiveness of Long-Term Ticagrelor in Patients With Prior Myocardial Infarction : Results From the PEGASUS-TIMI 54 Trial. Journal of the American College of Cardiology 70: 527-538, No. 5, 1 Aug 2017. Available from: URL: https://doi.org/10.1016/j.jacc.2017.05.063. 2. Navarese EP, et al. Striking the Balance Between Benefits and Costs of Ticagrelor Beyond 1 Year After Myocardial Infarction. Journal of the American College of Cardiology 70: 539-541, No. 5, 1 Aug 2017. Available from: URL: https://doi.org/10.1016/j.jacc.2017.06.025. 1173-5503/17/0784-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved PharmacoEconomics & Outcomes News 12 Aug 2017 No. 784
PharmacoEconomics & Outcomes News – Springer Journals
Published: Aug 12, 2017
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