Ticagrelor a cost-efficient alternative to clopidogrel for ACS patients

February 5, 2015 – An economic analysis of the PLATO trial by DCRI researchers found that the slight increase in cost for ticagrelor was offset by expected gains in mortality.

In an economic analysis of the Platelet Inhibition and Patient Outcomes (PLATO) trial, DCRI researchers found that ticagrelor is a cost-efficient substitute for clopidogrel for patients with acute coronary syndrome (ACS).

The study, which appears in the February issue of the Journal of the American College of Cardiology, was conducted by Patricia Cowper, PhD; Wenqin Pan, PhD; Kevin Anstrom, PhD; Linda Davidson-Ray, MA; and Daniel Mark, MD, MPH, along with researchers from other institutions.

Current treatment guidelines for ACS patients recommend dual antiplatelet therapy consisting of aspirin and an adenosine diphosphate receptor P2Y12 inhibitor. Although clopidogrel is the most commonly used inhibitor, researchers have been searching for a more efficient and reliable drug. The PLATO trial, which showed that ticagrelor was superior to clopidogrel when used in dual antiplatelet therapy, led to the U.S. Food and Drug Administration approving ticagrelor for use in ACS patients in combination with low-dose aspirin.

In this study, Cowper and her colleagues examined data from PLATO to gauge ticagrelor’s cost-efficiency compared with clopidogrel. They collected data on resource use from case report forms, including dates of hospital admission and discharge; days in intensive care (for follow-up care); and details about major procedures, therapies, and diagnostic tests, including percutaneous coronary revascularization, cardiac surgeries, coronary angiography, noninvasive cardiac imaging, and transfusions. Life expectancy was estimated using data from the original PLATO study cohort of 18,624 patients.

Resource use for both clopidogrel and ticagrelor patients was similar. When costs for the drugs themselves were factored into the analysis, treatment with ticagrelor was slightly more expensive than clopidogrel. One year of ticagrelor therapy, relative to that of generic clopidogrel, cost $29,665 per quality-adjusted life-year gained, with 99 percent of estimates falling under $100,000. This was offset by the mortality benefit conferred by treatment with ticagrelor, the researchers noted.

The cost-effectiveness of ticagrelor improved when the researchers removed the quality-of-life adjustment and when they excluded the annual cost of medical care beyond the PLATO trial. The cost-effectiveness of ticagrelor also improved if the average cost of clopidogrel was raised to the proprietary cost of $6 per day.

The researchers cautioned that their analysis was limited to the use of clopidogrel and ticagrelor in the U.S. health care system. Moreover, they noted, the financial impact of widespread use of ticagrelor could still be substantial in the context of the nation’s current multi-payer system.