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Ticagrelor plus aspirin may be cost-effective in patients with prior MI
Patients who are treated with ticagrelor and aspirin at least 1 year after an MI provided intermediate cost-effectiveness compared with treatment with aspirin alone, according to new data from the PEGASUS-TIMI 54 study.
Elizabeth A. Magnuson, ScD , professor of medicine at the University of Missouri at Kansas City School of Medicine and director of health economics and technology assessment at St. Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues performed a prospective health economic evaluation on data from the PEGASUS-TIMI 54 trial, which included patients aged 50 years and older who had a spontaneous MI 1 to 3 years before enrollment and were at high risk for a major ischemic event.
Ticagrelor vs. placebo
For the substudy, researchers analyzed patients who were assigned 60 mg ticagrelor (Brilinta, AstraZeneca) and low-dose aspirin (n = 7,040; mean age, 66 years; 76% men) vs. those assigned placebo and low-dose aspirin (n = 7,067; mean age, 66 years; 76% men). Quality-adjusted life-years and life-years were used to assess the cost-effectiveness for both treatments over a lifetime horizon.
At a median of 33 months, patients assigned ticagrelor had a reduced risk for MI, CV death or stroke (HR = 0.84; 95% CI, 0.74-0.95) compared with placebo.
Total hospitalization costs for patients assigned ticagrelor was $2,262 vs. $2,333 for the placebo group (95% CI for difference, –303 to 163). Hospitalization costs increased for patients assigned ticagrelor ($10,016) after the cost of the medication ($10.52 per day) was included, whereas costs for patients assigned placebo were the same ($2,333; 95% CI for difference, 7,441-7,930).
QALYs were similar for the ticagrelor and placebo groups (2.28 and 2.27, respectively; P = .34).
Lifetime cost-effectiveness
In lifetime cost-effectiveness results, patients assigned ticagrelor had incremental costs of $7,435 (95% CI, 7,137-7,670) and QALY gains of 0.078 (95% CI, 0.001-0.149). The incremental cost-effectiveness ratio that compared ticagrelor with placebo was $94,917 per QALY gained.
Patients with more than one prior MI, renal dysfunction, multivessel CAD and diabetes had an incremental cost-effectiveness ratio between $50,000 and $70,000 per QALY gained. Patients older than 75 years ($44,779) and those with peripheral artery disease ($13,427) also had favorable incremental cost-effectiveness ratios.
“These benefits are largely due to the combined impact of the absolute reduction in CV (and all-cause) mortality observed during the trial and the observed and projected impact of nonfatal MI and stroke events on long-term mortality and quality of life,” Magnuson and colleagues wrote.
“It is our opinion that future studies should be directed to the generation of personalized medicine models that ultimately integrate the demographic characteristics, biological data and genomic information of patients,” Eliano P. Navarese, MD, PhD, of the Inova Center for Thrombosis Research and Drug Development at the Inova Heart and Vascular Institute in Falls Church, Virginia, and Jan G.P. Tijssen, PhD, of the Systematic Investigation and Research on Interventions and Outcomes MEDICINE Research Network in Falls Church, wrote in a related editorial. “These models should target antiplatelet therapy with the potential to usher in a new era of individualized treatment strategies that maximize the clinical efficacy while minimizing bleeding complications and associated costs.” – by Darlene Dobkowski
Disclosures: The study was funded by AstraZeneca. Magnuson reports receiving grant support from Abbott Vascular, AstraZeneca, Boston Scientific, CSI, Daiichi Sankyo, Edwards Lifesciences, Eli Lilly, Medtronic and Merck, and consultant fees from Daiichi Sankyo. Navarese reports receiving speaker fees from Amgen and Sanofi-Regeneron and grants from Amgen. Tijssen reports no relevant financial disclosures. Please see the study for all other author’s relevant financial disclosures.