Cost Utility of Prasugrel in Postangioplasty Diabetic Patients

Matheus Piccin Padilla; Luana Schroeder Damico Nascimento Macedo; Ana Cláudia Wekmuller França; Isandra Meirelles; Carlos Alberto da Silva Magliano; Marisa da Silva Santos

doi:10.1016/j.vhri.2021.11.004

Cost Utility of Prasugrel in Postangioplasty Diabetic Patients

Value Health Reg Issues. 2022 Jul:30:134-139. doi: 10.1016/j.vhri.2021.11.004. Epub 2022 Apr 13.

Authors

Matheus Piccin Padilla¹, Luana Schroeder Damico Nascimento Macedo², Ana Cláudia Wekmuller França², Isandra Meirelles², Carlos Alberto da Silva Magliano², Marisa da Silva Santos²

Affiliations

¹ Health Technology Assessment Unit of the Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil. Electronic address: matheuspiccin@gmail.com.
² Health Technology Assessment Unit of the Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.

PMID: 35429926
DOI: 10.1016/j.vhri.2021.11.004

Abstract

Objectives: To prevent thrombotic events after angioplasty, current guidelines recommend dual antiplatelet therapy with aspirin and thienopyridine. Clopidogrel is the only thienopyridine currently available in the Brazilian National Health System. The purpose of this study was to determine the cost-effectiveness of prasugrel, an alternative thienopyridine, compared with clopidogrel in patients with acute coronary syndrome and diabetes mellitus who underwent angioplasty.

Methods: A state-transition Markov model was created to simulate the progression of diabetic patients after angioplasty. The model had a lifetime horizon and discounted outcomes at a 5% annual rate. The risks of myocardial infarction and death were calculated using data from the diabetes subgroup, and the risks of bleeding were calculated using data from the overall group from the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel Thrombolysis in Myocardial Infarction 38 trial. Direct costs were estimated using official Brazilian open data. Quality of life values were obtained through literature search. Univariate and multivariate sensitivity analyses were performed.

Results: Prasugrel was associated with more quality-adjusted life-years (QALYs) (5.03 vs 4.94) and higher costs (US$975.11 vs US$575.97), resulting in an incremental cost-utility ratio (ICUR) of US$4303.86/QALY. In one-way sensitivity analysis, the costs of prasugrel had the greatest impact on ICUR, followed by the initial age entering the cohort. In the probabilistic sensitivity analysis, all ICUR values simulations were less than one Brazilian gross domestic product per capita/QALY (US $5802.86).

Conclusions: Given the appealing economic profile, the clinical debate between reducing the risk of myocardial infarction and increasing the risk of bleeding may overcome economic concerns in the Brazilian National Health System.

Keywords: acute coronary syndrome; cost-benefit analysis; economic; models; platelet aggregation inhibitors.

MeSH terms

Clopidogrel / therapeutic use
Diabetes Mellitus* / drug therapy
Hemorrhage / drug therapy
Humans
Myocardial Infarction* / drug therapy
Platelet Aggregation Inhibitors / therapeutic use
Prasugrel Hydrochloride / therapeutic use
Quality of Life
Ticlopidine / therapeutic use

Substances

Platelet Aggregation Inhibitors
Clopidogrel
Prasugrel Hydrochloride
Ticlopidine