What is the clinical evidence from this study?

Population: Acute coronary syndromes (n=10686). Intervention: Ticagrelor vs. Generic clopidogrel. Primary outcome: Incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained (SGD 10,136 per QALY).

March 1, 2013Singapore Medical JournalOpen Access

Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective

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Key result

Ticagrelor treatment for one year in patients with acute coronary syndromes yielded a lifetime gain of 0.13 QALYs and an incremental cost-effectiveness ratio of SGD 10,136 per QALY gained.

Why the study?

Does ticagrelor improve lifetime cost-effectiveness compared to generic clopidogrel in patients with acute coronary syndromes?

Key Points

To evaluate the lifetime cost-effectiveness of ticagrelor compared with generic clopidogrel in patients with acute coronary syndromes from the perspective of Singapore's public healthcare system.
Constructed a two-part health economic model combining a 12-month decision tree based on PLATO trial outcomes with a Markov model to project lifetime quality-adjusted survival and costs.
Assigned daily drug costs of SGD 1.05 for generic clopidogrel and SGD 6.00 for ticagrelor, incorporating local life tables, short-term Singapore healthcare costs, and deterministic and probabilistic sensitivity analyses.
Ticagrelor achieved an incremental gain of 0.13 quality-adjusted life years (QALYs) over a patient's lifetime, driven primarily by lower mortality.
The incremental cost-effectiveness ratio was SGD 10,136.00 per QALY gained, with probabilistic sensitivity analysis indicating a > 99% probability of cost-effectiveness under the WHO threshold of one GDP per capita.

Structured PICO

Does ticagrelor improve lifetime cost-effectiveness compared to generic clopidogrel in patients with acute coronary syndromes?

Population

10,686 patients with acute coronary syndromes modeled over a lifetime to evaluate the cost-effectiveness of 12-month treatment with ticagrelor versus clopidogrel from a Singapore public healthcare perspective.

Intervention

Ticagrelor (SGD 6.00/day) for 1 year.

Comparator

Generic clopidogrel (SGD 1.05/day) for 1 year.

Outcome

Lifetime incremental cost per quality-adjusted life year (QALY) gained.

Main Result

Effect estimate: SGD 10,136 per QALY

Ticagrelor is a cost-effective alternative to generic clopidogrel for patients with acute coronary syndromes in the Singapore public healthcare system.

Limitations

Assumptions made when applying the model to the Singapore context may not necessarily hold true
Analysis was performed with current costs and the ICER may change in the future with changes in costs
Assumes that the treatment of patients with ACS in the first year locally will be similar to that of patients in the PLATO study
Based on overall PLATO study results, which may differ from local clinical events and outcomes
Side-effects observed more frequently with ticagrelor, specifically dyspnoea, may result in increased unmeasured costs to patients
Assumptions made when applying the model to the Singapore context
Analysis performed with current costs which may change
Assumes local treatment in the first year is similar to PLATO study
Based on overall PLATO results which may differ from Singapore real-world outcomes
Dyspnea side-effects may result in increased costs not fully captured

Discussion

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Implication

Supports ticagrelor cost-effectiveness in Singapore ACS; extends trial data to local economic modeling.

Cite This Study

Ct et al. (2013) studied Acute coronary syndromes (n=10,686). Ticagrelor vs. Generic clopidogrel was evaluated on Incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained (SGD 10,136 per QALY). Ticagrelor treatment for one year in patients with acute coronary syndromes yielded a lifetime gain of 0.13 QALYs and an incremental cost-effectiveness ratio of SGD 10,136 per QALY gained.

synapsesocial.com/papers/6a9c6b1aa2aa65bfe0978f9b https://doi.org/10.11622/smedj.2013045

Topics

Dual antiplatelet therapy

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Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

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