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Thromb Haemost 2014; 111(01): 103-110
DOI: 10.1160/TH13-07-0557
Platelets and Blood Cells
Schattauer GmbH

Universal versus platelet reactivity assay-driven use of P2Y12 inhibitors in acute coronary syndrome patients

Cost-effectiveness analyses for six European perspectives
Craig I. Coleman
1   University of Connecticut School of Pharmacy, Storrs, Conneticut, USA
,
Brendan L. Limone
1   University of Connecticut School of Pharmacy, Storrs, Conneticut, USA
› Author Affiliations Financial support: This work was supported by Accumetrics, Inc., San Diego, California, USA. The authors maintained full control over the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation and review of the manuscript. Accumetrics, Inc. reviewed the final manuscript prior to submission. Drs. Coleman and Limone had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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Publication History

Received: 11 July 2013

Accepted after major revision: 08 September 2013

Publication Date:
21 November 2017 (online)

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Summary

Platelet reactivity assays (PRAs) can predict patients’ likely response to clopidogrel. As ticagrelor and prasugrel are typically considered first-line agents for acute coronary syndrome in Europe, we assessed the cost-effectiveness of universal compared to PRA-driven selection of these agents. A Markov model was used to calculate five-year costs (2013£/€), quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) for one-year of universal ticagrelor or prasugrel (given to all) compared to each agents’ corresponding PRA-driven strategy (ticagrelor/prasugrel in those with high platelet reactivity [HPR, >208 on the VerifyNow P2Y12 assay], others given generic clopidogrel). We assumed patients had their index event at 65–70 years of age and had a 42.7% incidence of HPR 24–48 hours post-revascularisation. The analysis was conducted from the perspective of six countries (France, Germany, Italy, Spain, the Netherlands and United Kingdom) and used a one-year cycle length. Event data for P2Y12 inhibitors were taken from multinational randomised trials and adjusted using country-specific epidemiologic data. Neither universal ticagrelor nor prasugrel were found to be cost-effective (all ICERs >40,250€ or £36,600/QALY) compared to their corresponding PRA-driven strategies in any of the countries evaluated. Results were sensitive to differences in P2Y12 Inhibitors costs and drug-specific relative risks of major adverse cardiac events. Monte Carlo simulation suggested universal ticagrelor or prasugrel were cost-effective in only 25–44% and 11–17% of 10,000 iterations compared to their respective PRA-driven strategies, when applying a willingness-to-pay threshold = €30,000 or £20,000/QALY. In conclusion, the universal use of newer P2Y12 inhibitors is not likely cost-effective compared to PRA-driven strategies.

Keywords

Platelet reactivity assay - acute coronary syndrome - antiplatelet agents - cost-effectiveness analysis - Markov model

 

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