Long-term cost effectiveness of ticagrelor in patients with acute coronary syndromes in Thailand

Springer Science and Business Media LLC - Tập 4 Số 1 - 2014
Sukit Yamwong1, Unchalee Permsuwan2, Sirana Tinmanee3, Piyamitr Sritara1
1Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
2Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
3AstraZeneca (Thailand) Ltd, Bangkok, 10120, Thailand

Tóm tắt

Abstract Objectives To evaluate the long-term cost-effectiveness of ticagrelor and ASA versus generic and branded clopidogrel and ASA in patients with ACS based on a Thai cost database. Methods A one-year decision tree and a long-term Markov model were constructed to estimate lifetime costs and quality-adjusted life years (QALYs). For the first year, data from PLATO (NCT00391872) were used to estimate the rate of cardiovascular events, resource use, and QALYs. For year 2 onwards, clinical effectiveness was estimated conditional on individual health states that occurred during the first year. Results In the base-case analysis, the incremental cost-effectiveness ratio (ICER) with ticagrelor was 292,504 ($9,476) and 60,055 ($1,946) THB($)/QALY compared with generic and branded clopidogrel, respectively. The probability of ticagrelor being cost-effective was above 99% at a threshold of 160,000 THB/QALY compared with branded clopidogrel. Conclusions This health economic analysis provides cost effectiveness data for ticagrelor compared with both generic and branded clopidogrel in Thailand. Based on this analysis, it appears that ticagrelor is an economically valuable treatment for ACS compared with branded clopidogrel within the Thai context.

Từ khóa


Tài liệu tham khảo

Srimahachota S, Kanjanavanit R, Boonyaratavej S, Boonsom W, Veerakul G, Tresukosol D: Demographic, management practices and in-hospital outcomes of Thai Acute Coronary Syndrome Registry (TACSR): the difference from the Western World. J Med Assoc Thai 2007, 90(suppl 1):S1-S11.

Srimahachota S, Boonyaratavej S, Kanjanavanit R, Sritara P, Krittayaphong R, Kunjara-Na-Ayudhya R, Tatsanavivat P: Thai Registry in Acute Coronary Syndrome (TRACS)–an extension of Thai Acute Coronary Syndrome Registry (TACS) group: lower in-hospital but still high mortality at one-year. J Med Assoc Thai 2012, 95(4):508–518.

Prachuabmor C, Weerakul K, Kanchanawanich R: Thai Acute Coronary Syndrome Registry Report. Health Systems Research Institute, Bangkok; 2004.

Anukoolsawat P, Sritara P, Teerawattananon Y: Costs of lifetime acute coronary syndrome treatment at Ramathibodi hospital. Thai Heart J 2006, 19: 132–143.

Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP: ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non -ST-elevation myocardial infarction. Circulation. 2012, 2012(14):875–910.

Storey RF, Husted S, Harrington RA, Heptinstall S, Wilcox RG, Peters G, Wickens M, Emanuelsson H, Gurbel P, Grande P, Cannon CP: Inhibition of platelet aggregation by AZD6140, a reversible oral P2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndromes. J Am Coll Cardiol 2007, 50: 1852–1856. 10.1016/j.jacc.2007.07.058

Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Investigators PLATO, Freij A, Thorsén M: Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009, 361: 1045–1057. 10.1056/NEJMoa0904327

Nikolic E, Janzon M, Hauch O, Wallentin L, Henriksson M: Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study. Eur Heart J 2013, 34: 220–228. 10.1093/eurheartj/ehs149

Permsuwan U, Guntawongwan K, Buddhawongsa P: Handling time in economic evaluation studies. In Thai National Health Technology Assessment Guideline. Edited by: Chaikledkaew U, Teerawattananon Y, Kongpitayachai S, Suksomboon N. Chulalongkorn University Press, Bangkok; 2009:161–185.

World Health Organization: Thai life table by country. 2009.., [http://www.who.int/healthinfo/statistics/]

Allen LA, O'Donnell CJ, Camargo CA Jr, Giugliano RP, Lloyd-Jones DM: Comparison of long-term mortality across the spectrum of acute coronary syndromes. Am Heart J 2006, 151: 1065–1071. 10.1016/j.ahj.2005.05.019

Taneja AK, Collinson J, Flather MD, Bakhai A, de Arenaza DP, Wang D, Adgey J, Fox KA: Mortality following non-ST elevation acute coronary syndrome: 4 years follow-up of the PRAIS UK Registry (Prospective Registry of Acute Ischaemic Syndromes in the UK). Eur Heart J 2004, 25: 2013–2018. 10.1016/j.ehj.2004.08.009

Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP: Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke 1993, 24: 796–800. 10.1161/01.STR.24.6.796

Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, Stewart-Wynne EG: Five year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000, 31: 2080–2086. 10.1161/01.STR.31.9.2080

Tamteerano Y, Khonputsa P, Chaikledkaew U, Teerawattananon Y, Lim S: Economic evaluation of HMG-CoA reductase inhibitors (statin) for primary prevention of cardiovascular diseases among Thai population. Graphico System, Bangkok; 2008.

Riewpaiboon A: Standard cost list for health technology assessment.., [http://www.hitap.net/costingmenu]

Central office for Healthcare Information: CHI news and announcement.., [http://www.chi.or.th/]

Drug and Medical Supply Information Center: Prices of drugs and medical supply.., [http://dmsic.moph.go.th/price.htm]

Bureau of Trade and Economics Indices, Ministry of Commerce: CPI (Medical care).., [http://www.price.moc.go.th/price/cpi/index_new_e.asp]

The Health Intervention and Technology Assessment Program: Policy Brief.., [http://hitap.net]

World Health Organization: CHOosing Interventions that are Cost Effective (WHO-CHOICE).., [http://www.who.int/choice/costs/CER_thresholds/en/index.html]

The World Bank: GDP per capita.., [http://data.worldbank.org/indicator/NY.GDP.PCAP.CD]

National Economic and Social Development Board: Thai Economic Performance in Q3 and Outlook for 2013 and 2014.., [http://eng.nesdb.go.th/]

Gomez Y, Adams E, Hoogmartens J: Analysis of purity in 19 drug product tablets containing clopidogrel: 18 copies versus the original brand. J Pharm Biomed Anal 2004, 34: 341–348. 10.1016/S0731-7085(03)00533-8

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 4 Số 1

Thông tin tác giả