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Peasah SK, Huang Y, Venditto J, Brekosky R, Belletti D, Campbell V, Manolis C, Good CB. Ticagrelor versus clopidogrel for recurrent myocardial infarction: An outcomes-based agreement. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100347. [PMID: 37920750 PMCID: PMC10618484 DOI: 10.1016/j.rcsop.2023.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023] Open
Abstract
Background Outcomes-based agreements (OBA) are performance-based risk-sharing agreements between manufacturers and payers which provide the opportunity for collection and evaluation of real-world outcomes to supplement clinical trials. Objectives To describe an OBA comparing ticagrelor to clopidogrel in patients admitted with acute coronary syndrome (ACS) and proportion of recurrent myocardial infarction (MI) in a real-world setting. Methods Commercial (CM) and Medicare (MC) insurance patients of a large regional health plan, who presented with ACS and were prescribed either ticagrelor or clopidogrel were prospectively analyzed. The cohort consisted of adults (18-85 years) discharged between January 1, 2019, and December 31, 2020, who were adherent to the study medications, within the confines of the OBA. The primary outcome of interest was the proportion of recurrent MI hospitalizations within one year of discharge. Results There were 500 patients who met inclusion criteria in the ticagrelor cohort and 648 in the clopidogrel cohort. The mean age of patients in the ticagrelor cohort was 61.5 ± 10.5 years old and 66.5 ± 10.2 years in the clopidogrel cohort. The proportion of patients with type 2 diabetes, hypertension, or a history of congestive heart failure at baseline in the ticagrelor cohort was 31%, 85%, 14% respectively, and 43%, 90%, and 32% respectively in the clopidogrel cohort. The overall proportion of hospitalization for recurrent MI was 1.00% in the ticagrelor and 3.13% in the clopidogrel cohorts. In the follow-up propensity-matched analysis, although recurrent MI hospitalization was higher in the clopidogrel cohort (1.69% vs 1.21%) it was not statistically significant (p-value 0.5242). Conclusion Patients presenting with ACS and treated with ticagrelor had a lower rate of hospitalization for recurrent MI compared to patients treated with clopidogrel cohort within the confines of an OBA in a real-world setting.
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Affiliation(s)
- Samuel K. Peasah
- Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, India
| | - Yan Huang
- Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, India
| | | | | | | | | | | | - Chester B. Good
- Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, India
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Pirhonen L, Gyllensten H, Fors A, Bolin K. Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1317-1327. [PMID: 32895879 PMCID: PMC7581585 DOI: 10.1007/s10198-020-01230-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Person-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (< 2 years). The cost-effectiveness of person-centred care in a longer time perspective is largely unknown. OBJECTIVES To estimate the mid-term cost-effectiveness of person-centred care compared to usual care for patients (< 65) with acute coronary syndrome, using a 2-year and a 5-year time perspective. METHODS The mid-term cost-effectiveness of person-centred care compared to usual care was estimated by projecting the outcomes observed in a randomized-controlled trial together with data from health registers and data from the scientific literature, 3 years beyond the 2-year follow-up, using the developed simulation model. Probabilistic sensitivity analyses were performed using Monte Carlo simulation. RESULTS Person-centred care entails lower costs and improved effectiveness as compared to usual care, for a 2-year time and a 5-year perspective. Monte Carlo simulations suggest that the likelihoods of the person-centred care being cost-effective compared to usual care were between 80 and 99% and between 75 and 90% for a 2-year and a 5-year time perspective (using a 500,000 SEK/QALY willingness-to-pay threshold). CONCLUSIONS Person-centred care was less costly and more effective compared to usual care in a 2-year and a 5-year time perspective for patients with acute coronary syndrome under the age of 65.
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Affiliation(s)
- Laura Pirhonen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
- Centre for Health Economics (CHEGU), Department of Economics, University of Gothenburg, Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
| | - Kristian Bolin
- Centre for Health Economics (CHEGU), Department of Economics, University of Gothenburg, Gothenburg, Sweden
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Ahrens I, Averkov O, Zúñiga EC, Fong AYY, Alhabib KF, Halvorsen S, Abdul Kader MABSK, Sanz‐Ruiz R, Welsh R, Yan H, Aylward P. Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox. Clin Cardiol 2019; 42:1028-1040. [PMID: 31317575 PMCID: PMC6788484 DOI: 10.1002/clc.23232] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/27/2019] [Accepted: 07/06/2019] [Indexed: 12/14/2022] Open
Abstract
Clinical guidelines for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long-term mortality risk than patients with ST-segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the "treatment-risk paradox"). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four "P" factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long-term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.
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Affiliation(s)
- Ingo Ahrens
- Augustinerinnen Hospital, Academic Teaching HospitalUniversity of CologneCologneGermany
| | - Oleg Averkov
- Pirogov Russian National Research Medical UniversityMoscowRussia
| | | | - Alan Y. Y. Fong
- Department of CardiologySarawak Heart CentreKota SamarahanMalaysia
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac CentreCollege of Medicine, King Saud UniversityRiyadhSaudi Arabia
| | | | | | | | - Robert Welsh
- Mazankowski Alberta Heart Institute and University of AlbertaEdmontonAlbertaCanada
| | | | - Philip Aylward
- South Australian Health and Medical Research InstituteFlinders University and Medical CentreAdelaideAustralia
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Health Economic Analysis of Antiplatelet Therapy for Acute Coronary Syndromes in the Context of Five Eastern Asian Countries. Clin Drug Investig 2018; 38:621-630. [DOI: 10.1007/s40261-018-0649-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Analisi di Budget Impact di Ticagrelor nel Trattamento di Prevenzione in Pazienti con Sindrome Coronarica Acuta. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2017. [DOI: 10.5301/grhta.5000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gencer B, Rodondi N, Auer R, Nanchen D, Räber L, Klingenberg R, Pletscher M, Jüni P, Windecker S, Matter CM, Lüscher TF, Mach F, Perneger TV, Girardin FR. Health utility indexes in patients with acute coronary syndromes. Open Heart 2016; 3:e000419. [PMID: 27252878 PMCID: PMC4885435 DOI: 10.1136/openhrt-2016-000419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/15/2016] [Accepted: 04/25/2016] [Indexed: 11/14/2022] Open
Abstract
Background Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed. Methods We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population. Results Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p<0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (<0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p<0.01). Conclusions At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life.
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Affiliation(s)
- Baris Gencer
- Cardiology Division , Geneva University Hospitals, University of Geneva , Geneva , Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Reto Auer
- Department of Community Medicine and Ambulatory Care , University of Lausanne , Lausanne , Switzerland
| | - David Nanchen
- Department of Community Medicine and Ambulatory Care , University of Lausanne , Lausanne , Switzerland
| | - Lorenz Räber
- Department of Cardiology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Roland Klingenberg
- Department of Cardiology , University Heart Center , Zurich , Switzerland
| | - Mark Pletscher
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences , Winterthur , Switzerland
| | - Peter Jüni
- Institute of Primary Health Care, University of Bern, Bern, Switzerland; Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Stephan Windecker
- Department of Cardiology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Christian M Matter
- Department of Cardiology , University Heart Center , Zurich , Switzerland
| | - Thomas F Lüscher
- Department of Cardiology , University Heart Center , Zurich , Switzerland
| | - François Mach
- Cardiology Division , Geneva University Hospitals, University of Geneva , Geneva , Switzerland
| | - Thomas V Perneger
- Division of Clinical Epidemiology , University Hospital , Geneva , Switzerland
| | - François R Girardin
- Medical Directorate, University Hospital of Geneva, Geneva, Switzerland; Department of Anaesthesiology, Clinical Pharmacology, and Intensive Care Medicine, University Hospitals of Geneva, Switzerland
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Gencer B, Girardin F. Coronary artery disease is associated with persistent lower quality of life in women. Open Heart 2015; 2:e000305. [PMID: 26435841 PMCID: PMC4586939 DOI: 10.1136/openhrt-2015-000305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Baris Gencer
- Cardiology Division , University Hospital of Geneva , Geneva , Switzerland
| | - François Girardin
- Medical Directorate, University Hospital of Geneva , Geneva , Switzerland ; Department of Anesthesiology, Intensive Care and Clinical Pharmacology and Toxicology, University Hospitals and University of Geneva, Faculty of Medicine, Geneva, Switzerland
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Monitillo F, Iacoviello M, Caldarola P, Valle R, Chiatto M, Aspromonte N. Pharmacokinetics and pharmacodynamics of ticagrelor when treating non-ST elevation acute coronary syndromes. Expert Opin Drug Metab Toxicol 2015; 11:977-93. [DOI: 10.1517/17425255.2015.1037279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Economic Analysis of Ticagrelor Therapy From a U.S. Perspective. J Am Coll Cardiol 2015; 65:465-76. [DOI: 10.1016/j.jacc.2014.11.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/28/2014] [Accepted: 11/04/2014] [Indexed: 11/20/2022]
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Abstract
Ticagrelor (Brilique™, Brilinta®), a cyclopentyl-triazolopyrimidine, is an orally active, reversible, and selective adenosine diphosphate (ADP) receptor antagonist indicated for use in patients with acute coronary syndromes (ACS). Ticagrelor has a faster onset of action and provides greater inhibition of platelet aggregation than clopidogrel. In the large well-designed, PLATO study in adult patients with ACS, 12 months' treatment with ticagrelor was more effective than clopidogrel in reducing the incidence of the primary composite endpoint of myocardial infarction, stroke, or cardiovascular (CV) death. Ticagrelor also reduced all-cause mortality relative to clopidogrel, although statistical significance of this was not confirmed in hierarchical testing. Benefit with ticagrelor was seen both in invasively and noninvasively managed patients. Ticagrelor was generally well tolerated and was not associated with an increased risk of major bleeding relative to clopidogrel. However, the incidences of non-coronary artery bypass grafting (CABG)-related bleeding, and major or minor bleeding, as well as some non-hemorrhagic adverse events, including dyspnea (usually of mild or moderate severity) and ventricular pauses (largely asymptomatic) were higher with ticagrelor. In addition, the ATLANTIC study showed that although pre-hospital administration of ticagrelor did not improve pre-percutaneous coronary intervention (PCI) coronary reperfusion in ACS patients relative to in-hospital administration, ticagrelor was safe in both instances, with no significant between-group differences in non-CABG-related major and minor bleeding events. Although further comparative studies with other antiplatelet agents, including prasugrel, are required to position it more definitively, current evidence indicates that ticagrelor is a useful option for the prevention of thrombotic CV events in ACS patients managed invasively or noninvasively.
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