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

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Abstract

Introduction

The PLATelet inhibition and patient Outcomes (PLATO) trial (NCT00391872) demonstrated that ticagrelor compared to clopidogrel significantly reduced the rate of death from cardiovascular causes, myocardial infarction or stroke in patients with acute coronary syndrome (ACS). The aim of this study is to analyze the long-term cost-effectiveness of ticagrelor compared to clopidogrel in ACS patients from a Vietnamese healthcare payers' perspective.

Methods

A two-part cost-effectiveness model 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 EuroQol 5 Dimension (EQ-5D) data were derived from the PLATO trial. Unit costs of medical services were derived from the Vietnamese governmental price list, and drug costs were based on the weighted average price from the Vietnamese social security report (in VND; 10.000 VND = 0.405 USD). An annual discount rate of 3% was used. Probabilistic and deterministic sensitivity analyses were conducted to evaluate uncertainty of the results.

Results

Ticagrelor was associated with an incremental cost of VND 5.34 million (USD 216.49) and a QALY gain of 0.11. This resulted in a cost per QALY gained of VND 49.58 million (USD 2009.96) from the Vietnamese healthcare payers’ perspective. Probabilistic sensitivity analysis indicates that ticagrelor has 59% probability of being cost-effective compared with clopidogrel when using a willingness-to-pay threshold of one gross domestic products (GDP) per capita. Deterministic sensitivity analysis using clinical outcomes from the Asian sub-population of PLATO resulted in a cost per QALY of VND 42.25 million (USD 1712.80).

Conclusion

Ticagrelor can be considered a cost-effective treatment for ACS compared with clopidogrel from a Vietnamese healthcare payers' perspective.

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Acknowledgements

The authors would like to express our gratitude to the patients, collaborators participating in this study and the Board of Directors of the research hospitals including Cho Ray Hospital, Institut du Coeur Vietnam Heart Institute, Hanoi Heart Hospital and Hospital of University of Medicine and Pharmacy at Ho Chi Minh City for their support. We thank the staff of the related departments of these hospitals, who supported the implementation this study. We thank the participants of the study. We also express our gratitude to AstraZeneca, Vietnam, for their financial support for this study.

Funding

The PLATO trial was funded by AstraZeneca R&D, and this cost-effectiveness analysis was financially supported by AstraZeneca, Vietnam. The study sponsor did not fund the journal’s Rapid Service fee. Representatives of the sponsor were involved in the result interpretation together with other authors from academics and hospitals. The first and second listed authors drafted the report, and all authors agreed to submit the final version of the manuscript.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Disclosures

Thuy Nguyen Thi Thu declares that she has no conflict of interest. Dung Do Van declares that he has no conflict of interest. Tuan Nguyen Quang declares that he has no conflict of interest. Tuan Nguyen Quang has changed his affiliation to Bach Mai hospital after completion of manuscript. Hung Pham Manh declares that he has no conflict of interest. Sy Hoang Van declares that he has no conflict of interest. Carl Mellstrom is employed by Astra Zeneca in Sweden. Thinh Luu Cong, Tri Phuong Le are employed by Astra Zeneca in Vietnam. The sponsor financially supported the study. The publication of study results was not contingent on the sponsor’s approval or censorship of the manuscript.

Compliance with Ethics Guidelines

The study protocol was approved by Human Research Ethics Committee of the University of Medicine and Pharmacy at Ho Chi Minh city. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments. All participants provided written informed consent to participate in the study.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ Contributions

Thuy Thi Thu Nguyen contributed to the design of the study, data management, statistical analysis, cost-effectiveness analysis. Dung Van Do contributed to data management and statistical analysis. Carl Mellstrom contributed to statistical analysis and cost-effectiveness analysis. Tuan Quang Nguyen, Hung Manh Pham and Sy Van Hoang contributed to data collection in the study hospitals. Thinh Cong Luu contributed to cost-effectiveness analysis. Tri Le Phuong contributed to the design of the study. Thuy Thi Thu Nguyen drafted the manuscript, all other authors contributed to the review of the manuscript.

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Authors and Affiliations

  1. University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Thuy Thi Thu Nguyen, Dung Van Do & Sy Van Hoang

  2. AstraZeneca, CVRM BioPharmaceuticals, Gothenburg, Sweden

    Carl Mellstrom

  3. Hanoi Heart Hospital, Hanoi, Vietnam

    Tuan Quang Nguyen

  4. Vietnam Heart Institute, Hanoi, Vietnam

    Hung Manh Pham

  5. AstraZeneca Medical Affairs, Ho Chi Minh City, Vietnam

    Thinh Cong Luu & Tri Le Phuong

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  1. Thuy Thi Thu Nguyen
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Correspondence to Thuy Thi Thu Nguyen.

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Thi Thu Nguyen, T., Van Do, D., Mellstrom, C. et al. Cost-Effectiveness of Ticagrelor Compared with Clopidogrel in Patients with Acute Coronary Syndrome from Vietnamese Healthcare Payers’ Perspective. Adv Ther 38, 4026–4039 (2021). https://doi.org/10.1007/s12325-021-01743-5

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