Cost-Effectiveness of Ticagrelor Compared with Clopidogrel in Patients with Acute Coronary Syndrome from a Vietnamese Healthcare Payers’ Perspective

Abstract

Objectives: The PLATO trial (NCT00391872) demonstrated that ticagrelor (a P2Y12 inhibitor receptor) significantly reduced the rate of death from cardiovascular causes, myocardial infarction or stroke without an increase in major bleeding compared with clopidogrel in patients with acute coronary syndrome (ACS). The aim of this study is to analyze the long-term cost-effectiveness of ticagrelor compared with clopidogrel in patients with ACS from a Vietnamese healthcare payer perspective. Methods: A two-part cost-effectiveness model comprising a short-term decision tree and a long-term Markov structure was developed to estimate long-term costs and quality adjusted life years (QALY). Cardiovascular event rates, hospital bed days, interventions, investigations, study drug utilization and EQ5D data were derived from the PLATO trial. Direct costs of medical services was derived from the governmental price list for all hospitals in Vietnam, drug cost is based on the weighted average price from the report of Vietnamese social security at the time of analysis. Probabilistic and deterministic sensitivity analyses have been conducted to evaluate the uncertainty of the model. An annual discount rate of 3% was used for cost and outcomes. Results: Ticagrelor was associated with an incremental cost of VND 5.49 million and a QALY gain of 0.11. This resulted in a cost per QALY gained of VND 50.99 million from a Vietnamese healthcare payer perspective. Probabilistic sensitivity analysis indicates that ticagrelor has 55% probability of being cost-effective compared with clopidogrel when using a willingness-to-pay threshold of one GDP per capita or VND 53.5 million per QALY recommended by WHO. Deterministic sensitivity analysis using clinical outcomes from the Asian sub population of PLATO resulted in a cost per QALY of VND 33.29 million. Conclusions: Ticagrelor can be considered to be a cost-effective treatment for ACS compared with clopidogrel from a Vietnamese healthcare payer perspective.