Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999–3054.

    Article  Google Scholar 

  2. 2.

    Vengoechea F. Management of acute coronary syndrome in the hospital: a focus on ACCF/AHA guideline updates to oral antiplatelet therapy. Hosp Pract. 1995;2014(42):33–47.

    Google Scholar 

  3. 3.

    Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casay DE, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012;60:645–81.

    Article  Google Scholar 

  4. 4.

    O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362-425.

    PubMed  Google Scholar 

  5. 5.

    Task Force on the management of STseamiotESoC, Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–619.

    Article  Google Scholar 

  6. 6.

    Husted S, Emanuelsson H, Heptinstall S, Sandset PM, Wickens M, Peters G, et al. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur Heart J. 2006;27:1038–47.

    CAS  Article  Google Scholar 

  7. 7.

    Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045–57.

    CAS  Article  Google Scholar 

  8. 8.

    Writing Committee M, Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2012;126:875–910.

    Article  Google Scholar 

  9. 9.

    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;34:220–8.

    Article  Google Scholar 

  10. 10.

    Chin CT, Mellstrom C, Chua TSJ, Matchar DB. Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective. Singap Med J. 2013;54:169–75.

    Article  Google Scholar 

  11. 11.

    Cowper PA, Pan W, Anstrom KJ, Kaul P, Wallentin L, Davidson-Rayet L, et al. Economic analysis of ticagrelor therapy from a US perspective. J Am Coll Cardiol. 2015;65:465–76.

    Article  Google Scholar 

  12. 12.

    Lyseng-Williamson KA. Ticagrelor: a review of its cost effectiveness in the management of acute coronary syndromes. Drugs Ther Perspect. 2013;29:379–86.

    Article  Google Scholar 

  13. 13.

    Nguyễn TTT, Thân TTV, Nguyễn TTT, Phan TTN. Phân tích chi phí - hiệu quả của ticagrelor so với clopidogrel trong điều trị hội chứng mạch vành cấp: nghiên cứu theo quan điểm cơ quan bảo hiểm y tế Việt Nam. Tạp chí Y học Thành phố Hồ Chí Minh. 2017;21(1):313–20.

    Google Scholar 

  14. 14.

    Norhammar A, Stenestrand U, Lindback J, Wallentin L. Women younger than 65 years with diabetes mellitus are a high-risk group after myocardial infarction: a report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA). Heart. 2008;94:1565–70.

    CAS  Article  Google Scholar 

  15. 15.

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

    CAS  Article  Google Scholar 

  16. 16.

    James SK, Roe MT, Cannon CP, Cornel JH, Horrow J, Husted S, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for non-invasive management: substudy from prospective randomised PLATelet inhibition and patient Outcomes (PLATO) trial. BMJ. 2011;2011(342):d3527.

    Article  Google Scholar 

  17. 17.

    Edejer TT. World Health Organization. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization, 2003.

  18. 18.

    Johannesson M, Weinstein MC. On the decision rules of cost-effectiveness analysis. J Health Econ. 1993;12:459–67.

    CAS  Article  Google Scholar 

  19. 19.

    WHO Commission on Macroeconomics and Health. Macroeconomics and health: investing in health for economic development. Report of the Commission on Macroeconomics and Health. Geneva: World Health Organization, 2001.

  20. 20.

    The World Bank. GDP per capita (current US$) – Vietnam, https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=VN. Accessed 30 Nov 2018.

  21. 21.

    Kang HJ, Clare RM, Gao R, Held C, Himmelmann A, James SK, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: a retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. Am Heart J. 2015;169(899–905):e1.

    Google Scholar 

  22. 22.

    James S, Angiolillo DJ, Cornel JH, Erlinge D, Husted S, Kontny F, et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2010;31:3006–16.

    CAS  Article  Google Scholar 

  23. 23.

    Grima DT, Brown ST, Kamboj L, Bainey KA, Goeree R, Oh P, et al. Cost-effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes in Canada. Clinicoecon Outcomes Res. 2014;6:49–62.

    Article  Google Scholar 

  24. 24.

    Gasche D, Ulle T, Meier B, Greiner RA. Cost-effectiveness of ticagrelor and generic clopidogrel in patients with acute coronary syndrome in Switzerland. Swiss Med Wkly. 2013;143:w13851.

    PubMed  Google Scholar 

  25. 25.

    Yamwong S, Permsuwan U, Tinmanee S, Sritara P. Long-term cost effectiveness of ticagrelor in patients with acute coronary syndromes in Thailand. Heal Econ Rev. 2014;4(1):17.

    Article  Google Scholar 

  26. 26.

    Mejia A, Senior JM, Ceballos M, Atehortúa S, Toro JM, Saldarriaga C, et al. Cost-effectiveness analysis of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome in Colombia. Biomedica. 2015;35:531–40.

    PubMed  Google Scholar 

Download references

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Thuy Thi Thu Nguyen.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 19 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Ticagrelor
  • Clopidogrel
  • Acute coronary syndrome
  • Cost-effectiveness analysis
  • Vietnam