Cost-effectiveness of ticagrelor versus clopidogrel for the prevention of atherothrombotic events in adult patients with acute coronary syndrome in Germany
Tóm tắt
The aim of this health economic analysis was to compare the cost-effectiveness of ticagrelor versus clopidogrel within the German health care system. A two-part decision model was adapted to compare treatment with ticagrelor or clopidogrel in a low-dose acetylsalicylic acid (ASA) cohort (≤150 mg) for all ACS patients and subtypes NSTEMI/IA and STEMI. A decision-tree approach was chosen for the first year after initial hospitalization based on trial observations from a subgroup of the PLATO study. Subsequent years were estimated by a Markov model. Following a macro-costing approach, costs were based on official tariffs and published literature. Extensive sensitivity analyses were performed to test the robustness of the model. One-year treatment with ticagrelor is associated with an estimated 0.1796 life-years gained (LYG) and gained 0.1570 quality-adjusted life-years (QALY), respectively, over the lifetime horizon. Overall average cost with ticagrelor is estimated to be EUR 11,815 vs. EUR 11,387 with generic clopidogrel over a lifetime horizon. The incremental cost-effectiveness ratio (ICER) was EUR 2,385 per LYG (EUR 2,728 per QALY). Comparing ticagrelor with Plavix® or the lowest priced generic clopidogrel, ICER ranges from dominant to EUR 3,118 per LYG (EUR 3,567 per QALY). These findings are robust under various additional sensitivity analyses. Hence, 12 months of ACS treatment using ticagrelor/ASA instead of clopidogrel/ASA may offer a cost-effective therapeutic option, even when the generic price for clopidogrel is employed.
Tài liệu tham khảo
Zeymer U, Zahn R, Gitt A et al (2010) Aktuelle Versorgungsstruktur der Therapie des akuten Herzinfarkts in Deutschland. Der Kardiologe 4(3):231–235. doi:10.1007/s12181-010-0273-3
Robert Koch-Insitut (2006) Koronare Herzkrankheit und akuter Myokardinfarkt, Heft 33. http://www.gbe-bund.de. Accessed 5 Dec 2010
AOK Bundesverband, FEISA, WidO (2007) Qualitätssicherung der stationären Versorgung mit Routinedaten (QSR) Abschlussbericht 2007. Wissenschaftliches Insitut der AOK, editor. http://www.wido.de. Accessed: 4 July 2011
Damm K, Runge C, Zeymer U et al (2011) Krankheitskosten des akuten Koronarsyndroms in Deutschland. Der Kardiologe 5(2):122–128. doi:10.1007/s12181-011-0328-0
Zobel C, Dorpinghaus M, Reuter H et al (2012) Mortality in a cardiac intensive care unit. Clin Res Cardiol 101(7):521–524. doi:10.1007/s00392-012-0421-9
Peterson ED, Roe MT, Mulgund J et al (2006) Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA 295(16):1912–1920. doi:10.1001/jama.295.16.1912
Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31(20):2501–2555. doi:10.1093/eurheartj/ehq277
Wallentin L, Becker RC, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361(11):1045–1057
Mahaffey KW, Wojdyla DM, Carroll K et al (2011) Ticagrelor compared with clopidogrel by geographic region in the Platelet Inhibition and Patient Outcomes (PLATO) trial. Circulation 124(5):544–554. doi:10.1161/CIRCULATIONAHA.111.047498
AstraZeneca (2011) Fachinformation Brilique, Stand: Oktober 2011. Rote Liste® Service GmbH, editor. http://www.fachinfo.de. Accessed 28 June 2012
Gemeinsamer Bundesausschuss (2011) Ticagrelor—Dossier zur Nutzenbewertung gemäß §35a SGB V: Modul 4 Kodierung. http://www.g-ba.de. Accessed 11 Apr 2011
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (2011) Ticagrelor—Nutzenbewertung gemäß § 35a SGB V: Dossierbewertung; Auftrag: A11-02. http://www.iqwig.de. Accessed 24 Oct 2011
Henriksson M, Nikolic E, Janzon M, Hauch O, Levin LA, Wallentin L, For the PLATO health economic substudy group (2011) Long-term costs and health outcomes of treating acute coronary syndrome patients with ticagrelor based on the EU label—Cost-effectiveness analysis based on the PLATO study. Value in Health
Nikolic E, Janzon M, Hauch O et al (2012) Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study. Eur Heart J. doi:10.1093/eurheartj/ehs149
Haeusler KG, Konieczny M, Endres M et al (2011) Impact of anticoagulation before stroke on stroke severity and long-term survival. Int J Stroke. doi:10.1111/j.1747-4949.2011.00672.x
Gesundheitsberichterstattung des Bundes (2012) Diagnosedaten der Krankenhäuser ab 2000 (Fälle/Sterbefälle, Berechnungs- und Belegungstage, durchschnittliche Verweildauer). Gliederungsmerkmale: Jahre, Behandlungsort, Alter, Geschlecht, Verweildauer, ICD10. http://www.gbe-bund.de. Accessed 23 Oct 2011
Taylor MJ, Scuffham PA, McCollam PL et al (2007) Acute coronary syndromes in Europe: 1-year costs and outcomes. Curr Med Res Opin 23(3):495–503
Gesundheitsberichterstattung des Bundes (2011) Krankheitskosten je Einwohner in €. Gliederungsmerkmale: Jahre, Deutschland, Alter, Geschlecht, ICD10, Einrichtungen. http://www.gbe-bund.de. Accessed 23 Oct 2011
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (2009) Arbeitspapier Kostenbestimmung V1.0. http://www.iqwig.de. Accessed 11 Apr 2011
Janzon M, Lundborg E, Henriksson M et al. (2010) Abstract 17295: Health Economics in the PLATelet inhibition and Patient Outcomes (PLATO) Randomized Trial: Report on Within Trial Resource Use Patterns. Circulation 122 (21_MeetingAbstracts): A17295
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (2009) Arbeitspapier Modellierung V1.0. http://www.iqwig.de. Accessed 11 Apr 2011
Nöthen M (2011) Hohe Kosten im Gesundheitswesen: Eine Frage des Alters? Statistisches Bundesamt, editor. http://www.destatis.de. Accessed 11 Apr 2011
Anonym (2012) Preismeldungen. LAUER-FISCHER GmbH, editor. https://www.lauer-fischer.de/LF/Seiten/Verwaltung/Kundencenter.aspx. Accessed 29 June 2012
Institut für das Entgeltsystem im Krankenhaus (2011) DRG Browser. http://www.g-drg.de. Accessed 05 Dec 2011
Brüggenjürgen B, Rupprecht HJ, Willich SN (2005) Cost of atherothrombotic diseases-myocardial infarction, ischaemic stroke and peripheral arterial occlusive disease-in Germany. J Public Health 13:216–224
Rossnagel K, Nolte CH, Müller-Nordhorn J et al (2005) Medical resource use and costs of health care after acute stroke in Germany. Eur J Neurol 12:862–868
Zeidler J, Mittendorf T, Vahldiek G et al (2008) Kostenvergleichsanalyse der ambulanten und stationären kardiologischen Rehabilitation. Herz 33(440):447
Lamotte M, Annemanns L, Evers T et al (2006) A multi-country economic evaluation of low-dose aspirin in the primary prevention of cardiovascular disease. Pharmacoeconomics 24(2):155–169
Winter Y, Wolfram C, Schöffski O et al (2008) Langzeitkrankheitskosten 4 Jahre nach Schlaganfall oder TIA in Deutschland. Nervenarzt 79:918–926
Berger K, Hessel F, Kreuzer J et al (2008) Clopidogrel versus aspirin in patients with atherothrombosis: cAPRIE-based calculation of cost-effectiveness for Germany. Curr Med Res Opin 24(1):267–274
Gesundheitsberichterstattung des Bundes (2011) Arbeitsunfähigkeit bei AOK-Pflichtmitgliedern ohne Rentner (Arbeitsunfähigkeitsfälle, Arbeitsunfähigkeitsfälle je 100.000 Pflichtmitglieder, Arbeitsunfähigkeitstage, Arbeitsunfähigkeitstage je 100.000 Pflichtmitglieder,Tage je Fall). Gliederungsmerkmale: Jahre, Deutschland, Geschlecht, ICD-10. http://www.gbe-bund.de. Accessed 23 Oct 2011
Schulenburg JM, Greiner W, Jost F et al (2007) Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation—dritte und aktualisierte Fassung des Hannoveraner Konsens. Gesundh ökon Qual manag 12:285–290
Theidel U, Asseburg C, Giannitsis E, Katus H. Cost effectiveness of ticagrelor in the treatment of acute coronary syndrome (ACS) in Germany Abstract submitted to ISPOR 14th Annual European Congress. 2011
Schöffski O, Schulenburg JM (2007) Gesundheitsökonomische Evaluationen, 3rd edn. Springer, Berlin
Cohen M (2005) Predictors of bleeding risk and long-term mortality in patients with acute coronary syndromes. Curr Med Res Opin 21(3):439–445. doi:10.1185/030079905X30725
Stracke S, Dorr O, Heidt MC et al (2010) GRACE risk score as predictor of in-hospital mortality in patients with chest pain. Clin Res Cardiol 99(10):627–631. doi:10.1007/s00392-010-0160-8
Fitchett D (2007) The impact of bleeding in patients with acute coronary syndromes: how to optimize the benefits of treatment and minimize the risk. Can J Cardiol 23(8):663–671
Bufe A, Frey S, Briswalter S (2009) Durch Blutungen verursachte Kosten bei der Therapie des akuten Koronarsyndroms in Deutschland. Herz 479; 484
Kolominsky-Rabas PL, Heuschmann PU, Marschall D et al (2006) Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project. Stroke 37(5):1179–1183
Schweikert B, Hunger M, Meisinger C et al (2009) Quality of life several years after myocardial infarction: comparing the MONICA/KORA registry to the general population. Eur Heart J 30(4):436–443. doi:10.1093/eurheartj/ehn509
AstraZeneca. PLATO—A Study of PLATelet inhibition and Patient Outcomes (clinical study report). [unveröffentlicht] 2009
Dyer MTD, Goldsmith KA, Sharples LS et al. (2010) Are view of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Out 8: 13
Wiesner G, Grimm J, Bittner E (2002) Vorausberechnungen des Herzinfarktgeschehens in Deutschland. Bundesgesundheitsblatt 45:438–445
Hamm CW (2004) Leitlinien: Akutes Koronarsyndrom (ACS), Teil 2. Z Kardiol 93:324–341
Hamm CW (2004) Leitlinien: Akutes Koronarsyndrom (ACS), Teil 1. Z Kardiol 93:72–90
Anonym (2010) Threshold values for intervention cost-effectiveness by Region. Accessed 23 Oct 2010
Barbieri M, Drummond M, Willke R et al (2005) Variability of cost-effectiveness estimates for pharmaceuticals in Western Europe: lessons for inferring generalizability. Value Health 8(1):10–23
AstraZeneca. EMEA/H/C/1241: Ticagrelor Tablets Additional PLATO subgroup analysis on overall PLATO UA/NSTEMI and STEMI subgroups and ASA Γëñ150 mg cohort for the German Value Dossier. 2011