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One-Year Post-Discharge Resource Utilization and Treatment Patterns of Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention and Treated with Ticagrelor or Prasugrel

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Abstract

Objective

Our objective was to compare 1-year real-world healthcare resource utilization (HRU), associated charges, and antiplatelet treatment patterns among patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with ticagrelor or prasugrel.

Methods

Using the ProMetis-Lx database, adult ACS-PCI patients treated with ticagrelor or prasugrel post-discharge were identified between 1 August 2011 and 31 May 2013 and propensity matched to adjust for baseline differences.

Results

Before matching, ticagrelor-treated patients (n = 2991) were older with increased baseline ischemic and bleeding risks compared with prasugrel-treated patients (n = 12,797). After matching, ticagrelor patients had higher all-cause HRU (2.5 vs. 2.4 per patient per month; P = 0.012) and cardiovascular (CV) HRU (0.4 vs. 0.3 per patient per month; P = 0.026), with the difference in CV rehospitalizations (17.7 vs. 15.7 %; P = 0.011) primarily driven by congestive heart failure (CHF) (4.9 vs. 3.8 %; P = 0.02). All-cause charges within 1 year did not significantly differ between groups ($US5456 vs. 4844 per patient per month; P = 0.37), but dyspnea-related total charges were significantly higher with ticagrelor ($US139 vs. 95 per patient per month; P = 0.005). Although infrequent, switching was slightly higher with ticagrelor (8.3 vs. 6.0 %; P < 0.001) at 1 year, and mean persistence was slightly longer with prasugrel (150 vs. 159 days; P = 0.002), with no significant difference in mean adherence (61 vs. 63 %; P = 0.17).

Conclusion

Overall monthly HRU was slightly lower with prasugrel than with ticagrelor, with no significant difference in bleeding HRU. Prasugrel was associated with slightly higher pharmacy charges, but lower dyspnea charges, resulting in no significant difference in total charges. Patients receiving prasugrel tended to use it for longer than those receiving ticagrelor as less switching occurred. These findings may aid decision making, but must be tempered due to inherent study limitations.

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Acknowledgments

The authors thank Doug Faries, PhD, Hsiao Lieu, MD, William Malatestinic, PharmD, and Nayan Acharya, MD, at Eli Lilly and Company; Qiaoyi Zhang, PhD, at Daiichi Sankyo Inc.; and Teresa Bennett, PhD, and Jaime Lucove, MSPH, at Symphony Health Solutions, for valuable contributions to this study and manuscript.

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Authors and Affiliations

  1. Retrospective Observational Studies, Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA

    Jason C. Simeone, Beth L. Nordstrom & Brian R. Murphy

  2. Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA

    Cliff Molife, Mark B. Effron, Yajun E. Zhu, Stuart Keller & Patrick L. McCollam

  3. Daiichi Sankyo Inc., Parsippany, NJ, USA

    Elizabeth Marrett & Feride Frech-Tamas

  4. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA

    Kavita V. Nair & Robert L. Page II

  5. Allied Health Professions School, Virginia Commonwealth University, Richmond, VA, USA

    George W. Vetrovec

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  1. Jason C. Simeone
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Corresponding author

Correspondence to Cliff Molife.

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Declaration of Funding

This study was funded by Daiichi Sankyo Inc., Parsippany, NJ, USA, and Eli Lilly and Company, Indianapolis, IN, USA.

Conflict of interest

CM, SK, YEZ, PLM, and MBE are employees of Eli Lilly and Company. FF and EM are employees of Daiichi Sankyo, Inc. GV is an unpaid consultant to Daiichi Sankyo and Eli Lilly. KVN and RLP, II are paid consultants to Daiichi Sankyo and Eli Lilly. JCS, BLN, and BM are employed by Evidera, which received funding from Eli Lilly and Company and Daiichi Sankyo Inc. to conduct this research and prepare this manuscript.

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Simeone, J.C., Molife, C., Marrett, E. et al. One-Year Post-Discharge Resource Utilization and Treatment Patterns of Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention and Treated with Ticagrelor or Prasugrel. Am J Cardiovasc Drugs 15, 337–350 (2015). https://doi.org/10.1007/s40256-015-0147-y

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