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

Andrew Davies, Mark Sculpher, Annabel Barrett, Teresa Huete, José Antonio Sacristán del Castillo, Tatiana Dilla

• 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