Prasugrel compared to clopidogrel in patients with acute coronary syndrome undergoing percutenous coronary intervention: a Spanish model-based cost-effectiveness analysis

• Autores: Andrew Davies, Mark Sculpher, Annabel Barrett, Teresa Huete, José Antonio Sacristán del Castillo, Tatiana Dilla
• Localización: Farmacia hospitalaria: órgano oficial de expresión científica de la Sociedad Española de Farmacia Hospitalaria, ISSN-e 1130-6343, ISSN 1130-6343, Vol. 37, Nº. 4, 2013, págs. 307-316
• Idioma: inglés
• Títulos paralelos:
  • Prasugrel frente a clopidogrel en pacientes con síndrome coronario agudo sometidos a intervención coronaria percutánea: análisis de coste-efectividad basado en un modelo español
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• Resumen

  • Objective:

    To assess the long-term cost-effectiveness of 12 months treatment of prasugrel compared to clopidogrel in patients with acute coronary syndrome (ACS) undergoing per- cutaneous coronary intervention (PCI) in the Spanish health care system.

    Methods:

    A Markov state transition model was developed to estimate health outcomes, quality adjusted life years (QALYs), life years (LY), and costs over patients� lifetimes. Clinical inputs were based on an analysis of the TRITON-TIMI 38 clin- ical trial. Hospital readmissions captured during the trial in a sub-study of patients from eight countries (and subsequent re-hospitalisations modelled to accrue beyond the time hori- zon of the trial), were assigned to Spanish diagnosis-related group payment schedules to estimate hospitalisation costs.

    Results:

    Mean total treatment costs were � 11,427 and � 10,910 for prasugrel and clopidogrel respectively. The mean cost of the study drug was � 538 higher for prasugrel vs.

    clopidogrel, but rehospitalisation costs at 12 months were � 79 lower for prasugrel due to reduced rates of revasculari- sation. Hospitalisation costs beyond 12 months were higher with prasugrel by � 55, due to longer life expectancy (+0.071 LY and +0.054 QALYs) associated with the decreased non- fatal myocardial infarction rate in the prasugrel group. The incremental cost per life year and QALY gained with prasugrel was � 7,198, and � 9,489, respectively.

    Conclusion:

    Considering a willingness-to-pay threshold of � 30,000/QALY gained in the Spanish setting, prasugrel repre- sents a cost-effective option in comparison with clopidogrel among patients with ACS undergoing PCI