Cost-Effectiveness Comparison between Ticagrelor and Clopidogrel in Acute Coronary Syndrome in Iran

Amir Hashemi-Meshkini; Amirmohammad Tajik; Nayyereh Ayati; Shekoufeh Nikfar; Reza Koochak; Saeed Yaghoubifard; Azam Abbasi; Mehdi Varmaghani

doi:10.18502/jthc.v18i2.13318

Amir Hashemi-Meshkini Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Amirmohammad Tajik School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
Nayyereh Ayati Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Shekoufeh Nikfar Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Reza Koochak Promethean BioPharma Limited, Sydney, Australia.
Saeed Yaghoubifard Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Azam Abbasi Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Mehdi Varmaghani Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

DOI: https://doi.org/10.18502/jthc.v18i2.13318

Keywords: Acute coronary syndrome; Ticagrelor; Clopidogrel; Cost-effectiveness analysis

Abstract

Background: The present study aimed to determine the cost-effectiveness of ticagrelor compared with clopidogrel in Iranian patients with acute coronary syndrome (ACS).

Methods: A 1-year decision tree model combined with a 20-year Markov transition model was used to simulate the long-term cost and effectiveness of both ticagrelor and clopidogrel in Iran based on an Iranian payer’s perspective. Clinical efficacy data were extracted from the PLATO trial and other published studies. Costs were estimated based on local prices in public sectors. Deterministic and probabilistic sensitivity analyses were used to test the robustness of base-case results over the uncertainties of model inputs. All calculations, analyses, and modeling were done in TreeAge 2011 and Microsoft Excel 2013.

Results: Compared with clopidogrel, the treatment of Iranian ACS patients with ticagrelor for 20 years resulted in an additional cost of US$ 2.39 in a hypothetical cohort of 1000 patients. However, ticagrelor led to 7.2 quality-adjusted life-years (QALYs) gained per 1000 hypothetical patients. Accordingly, the estimated incremental cost-effectiveness ratio for this analysis was US$ 332.032 per 1 QALY gained.

Conclusion: Ticagrelor was a cost-effective antiplatelet medicine compared with clopidogrel in Iranian patients with ACS. This could help Iran’s policymakers to allocate resources more efficiently to ACS.