| Peer-Reviewed

Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis

Received: 8 September 2020     Accepted: 6 October 2020     Published: 17 October 2020
Views:       Downloads:
Abstract

This study aimed to evaluate the long-term cost-effectiveness of ticagrelor plus aspirin versus generic clopidogrel plus aspirin in acute coronary syndrome patients in Hong Kong (HK) from a public hospital’s perspective. The study has adapted a previously developed two-component prediction model. The first component is a simple decision tree corresponding to the first year. Afterwards events in the second year onwards were estimated using a state-transition Markov model incorporating the potential of recurrent events such as myocardial infarction and strokes that could lead to death for estimating the long-term economic and health outcomes measured as cost per quality-adjusted life year (QALYs). Kaplan Meier survival analysis was employed to determine the risk of events. Probabilistic sensitivity analysis was used to estimate the probability of ticagrelor being cost-effective. A cost-effectiveness acceptability curve was used to estimate the willingness-to-pay of patients. The use of ticagrelor led to improved clinical outcomes by gaining additional life-years and QALYS over 5-year and lifetime time horizons. The incremental cost-effectiveness ratio was above 1 Gross Domestic Product (GDP) per capita only for the 1-year results. By replacing clopidogrel with ticagrelor for life-time, the incremental drug costs were offset by the substantial reduction in other direct costs, leading to an overall cost-savings of HK 2,878 per patient. The probabilistic sensitivity analysis showed that ticagrelor has 53.5% chance of being dominant and 34.7% being cost-effective at a threshold of 1 GDP per capita for Hong Kong. A cost-effectiveness acceptability curve also showed that the willingness-to-pay for ticagrelor was 90% at 1 GDP per capita. Ticagrelor plus aspirin appeared to be cost-effective over 5-year and life-time projection periods compared to clopidogrel plus aspirin.

Published in International Journal of Health Economics and Policy (Volume 5, Issue 3)
DOI 10.11648/j.hep.20200503.13
Page(s) 63-71
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Ticagrelor, Acute Coronary Syndrome, Health Utility Analysis, Simulation Model, Cost Per QALY

References
[1] Department of Health The government of the Hong Kong Special Administrative Region: Coronary Heart Disease. Available from: http://www.healthyhk.gov.hk/phisweb/en/healthy_facts/disease_burden/major_causes_death/coronary_heart_disease/. Accessed 28 September 2018.
[2] Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 64 (24): e139-e228.
[3] Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361: 1045-57.
[4] James SK, Roe MT, Cannon CP, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for non-invasive management: substudy from prospective randomised PLATelet inhibition and patient Outcomes (PLATO) trial. BMJ. 2011; 342: d3527.
[5] Kang HJ, Clare RM, Gao R, Held C, Himmelmann A, James SK, Lim ST, Santoso A, Yu CM, Wallentin L, Becker RC; PLATO Investigators. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. Am Heart J. 2015 Jun; 169 (6): 899-905. e1. doi: 10.1016/j.ahj.2015.03.015.
[6] Nikolic E, Janzon M, Hauch O, et al. Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study. Eur Heart J. 2013; 34: 220-8.
[7] Theidel U, Asseburg C, Giannitsis E, et al. Cost-effectiveness of ticagrelor versus clopidogrel for the prevention of atherothrombotic events in adult patients with acute coronary syndrome in Germany. Clin Res Cardiol. 2013; 102: 447-58.
[8] Grima DT, Brown ST, Kamboj L, et al. Cost-effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes in Canada. Clinicoecon Outcomes Res. 2014; 6: 49-62.
[9] Yamwong S, Permsuwan U, Tinmanee S, et al. Long-term cost effectiveness of ticagrelor in patients with acute coronary syndromes in Thailand. Health Economics Review. 2014; 4: 1-7.10.
[10] Chin CT, Mellstrom C, Chua TS, et al. Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective. Singapore Med J. 2013; 54: 169-75.
[11] Dennis MS, Burn JP, Sandercock PA, et al. Long term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke. 1993; 24: 796-800.
[12] Olai L, Omne-Ponten M, Borgquist L, et al. Survival, hazard function for a new event, and healthcare utilization among stroke patients over 65 years old. Stroke. 2009; 40: 3585-90.
[13] Ministry of Health Singapore: Hospital Bill Sizes. 2013. http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/HospitalBillSize.html. Accessed 16 Sept 2018.
[14] Management Center for Health Promotion, Republic of Korea. Cost- effectiveness analysis of national prevention programs for cardiovascular disease. 2007.
[15] Census and Statistics Department. Hong Kong life tables 1971-2018. http://www.censtatd.gov.hk/hkstat/sub/sp190.jsp?productCode=D5320184. Accessed 20 August 2018.
[16] Burström K, Johannesson M, Rehnberg C. Deteriorating health status in Stockholm 1998-2002: results from repeated population surveys using the EQ-5D. Qual Life Res. 2007; 16: 1547-53.
[17] Census and Statistics Department. Hong Kong Population Projections 2010-2039. Available at: http://www.statistics.gov.hk/pub/B1120015042010XXXXB0100.pdf. 2010. Accessed 1 Sept 2018.
[18] Lee VWY, Chan WK, Lam NLC, et al. Cost of acute myocardial infarction in Hong Kong. Dis Manage Health Outcomes. 2005; 13: 281-5.
[19] Hui E, Lum CM, Woo J, et al. Outcomes of elderly stroke patients day hospital versus conventional medical management. Stroke. 1995; 26: 1616-19.
[20] Statistics Sweden. Life Tables 2005-2009 for men and women. 2017. http://www.scb.se. Accessed 23 Sept 2018.
[21] Burström K, Rehnberg C. Health-related quality of life in Stockholm County 2002. Results from repeated population surveys using the EQ-5D. 2007. https://www.researchgate.net/publication/6011225_Deteriorating_health_status_in_Stockholm_1998-2002_Results_from_repeated_population_surveys_using_the_EQ-5D. Accessed 1 Oct 2018.
[22] Census and Statistics Department. https://www. censtatd.gov.hk/hkstat/hkif/index.jsp. 2018 Accessed 20 Sept 2018.
[23] Census and Statistics Department. The Government of the Hong Kong Special Adminsitrative Region. 2018. http:// www.censtatd.gov.hk/hkstat/sub/bbs.jsp. Accessed 30 Sept 2018.
[24] Choosing interventions that are cost-effective. Geneva: World Health Organization. 2014. http://www.who.int/choice/en/Accessed28Sept2018.
[25] Collett D. Modelling Survival Data. In: Medical Research. 2nd ed. London: Chapman and Hall/CRC; 2003.
[26] Briggs AH, Claxton K, Sculpher MJ. In: Decision Modelling for Health Economic Evaluation. Oxford: Oxford University Press; 2006.
[27] https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10036&Lang=ENG&Ver=HTML2018. Accessed 28 Sept 2019.
Cite This Article
  • APA Style

    David Bin-Chia Wu, June Wai Yee Choon, Chun Wie Chong, Benjamin Shing Cheung Lee, Kenneth Kwing Chin Lee. (2020). Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis. International Journal of Health Economics and Policy, 5(3), 63-71. https://doi.org/10.11648/j.hep.20200503.13

    Copy | Download

    ACS Style

    David Bin-Chia Wu; June Wai Yee Choon; Chun Wie Chong; Benjamin Shing Cheung Lee; Kenneth Kwing Chin Lee. Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis. Int. J. Health Econ. Policy 2020, 5(3), 63-71. doi: 10.11648/j.hep.20200503.13

    Copy | Download

    AMA Style

    David Bin-Chia Wu, June Wai Yee Choon, Chun Wie Chong, Benjamin Shing Cheung Lee, Kenneth Kwing Chin Lee. Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis. Int J Health Econ Policy. 2020;5(3):63-71. doi: 10.11648/j.hep.20200503.13

    Copy | Download

  • @article{10.11648/j.hep.20200503.13,
      author = {David Bin-Chia Wu and June Wai Yee Choon and Chun Wie Chong and Benjamin Shing Cheung Lee and Kenneth Kwing Chin Lee},
      title = {Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis},
      journal = {International Journal of Health Economics and Policy},
      volume = {5},
      number = {3},
      pages = {63-71},
      doi = {10.11648/j.hep.20200503.13},
      url = {https://doi.org/10.11648/j.hep.20200503.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20200503.13},
      abstract = {This study aimed to evaluate the long-term cost-effectiveness of ticagrelor plus aspirin versus generic clopidogrel plus aspirin in acute coronary syndrome patients in Hong Kong (HK) from a public hospital’s perspective. The study has adapted a previously developed two-component prediction model. The first component is a simple decision tree corresponding to the first year. Afterwards events in the second year onwards were estimated using a state-transition Markov model incorporating the potential of recurrent events such as myocardial infarction and strokes that could lead to death for estimating the long-term economic and health outcomes measured as cost per quality-adjusted life year (QALYs). Kaplan Meier survival analysis was employed to determine the risk of events. Probabilistic sensitivity analysis was used to estimate the probability of ticagrelor being cost-effective. A cost-effectiveness acceptability curve was used to estimate the willingness-to-pay of patients. The use of ticagrelor led to improved clinical outcomes by gaining additional life-years and QALYS over 5-year and lifetime time horizons. The incremental cost-effectiveness ratio was above 1 Gross Domestic Product (GDP) per capita only for the 1-year results. By replacing clopidogrel with ticagrelor for life-time, the incremental drug costs were offset by the substantial reduction in other direct costs, leading to an overall cost-savings of HK 2,878 per patient. The probabilistic sensitivity analysis showed that ticagrelor has 53.5% chance of being dominant and 34.7% being cost-effective at a threshold of 1 GDP per capita for Hong Kong. A cost-effectiveness acceptability curve also showed that the willingness-to-pay for ticagrelor was 90% at 1 GDP per capita. Ticagrelor plus aspirin appeared to be cost-effective over 5-year and life-time projection periods compared to clopidogrel plus aspirin.},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis
    AU  - David Bin-Chia Wu
    AU  - June Wai Yee Choon
    AU  - Chun Wie Chong
    AU  - Benjamin Shing Cheung Lee
    AU  - Kenneth Kwing Chin Lee
    Y1  - 2020/10/17
    PY  - 2020
    N1  - https://doi.org/10.11648/j.hep.20200503.13
    DO  - 10.11648/j.hep.20200503.13
    T2  - International Journal of Health Economics and Policy
    JF  - International Journal of Health Economics and Policy
    JO  - International Journal of Health Economics and Policy
    SP  - 63
    EP  - 71
    PB  - Science Publishing Group
    SN  - 2578-9309
    UR  - https://doi.org/10.11648/j.hep.20200503.13
    AB  - This study aimed to evaluate the long-term cost-effectiveness of ticagrelor plus aspirin versus generic clopidogrel plus aspirin in acute coronary syndrome patients in Hong Kong (HK) from a public hospital’s perspective. The study has adapted a previously developed two-component prediction model. The first component is a simple decision tree corresponding to the first year. Afterwards events in the second year onwards were estimated using a state-transition Markov model incorporating the potential of recurrent events such as myocardial infarction and strokes that could lead to death for estimating the long-term economic and health outcomes measured as cost per quality-adjusted life year (QALYs). Kaplan Meier survival analysis was employed to determine the risk of events. Probabilistic sensitivity analysis was used to estimate the probability of ticagrelor being cost-effective. A cost-effectiveness acceptability curve was used to estimate the willingness-to-pay of patients. The use of ticagrelor led to improved clinical outcomes by gaining additional life-years and QALYS over 5-year and lifetime time horizons. The incremental cost-effectiveness ratio was above 1 Gross Domestic Product (GDP) per capita only for the 1-year results. By replacing clopidogrel with ticagrelor for life-time, the incremental drug costs were offset by the substantial reduction in other direct costs, leading to an overall cost-savings of HK 2,878 per patient. The probabilistic sensitivity analysis showed that ticagrelor has 53.5% chance of being dominant and 34.7% being cost-effective at a threshold of 1 GDP per capita for Hong Kong. A cost-effectiveness acceptability curve also showed that the willingness-to-pay for ticagrelor was 90% at 1 GDP per capita. Ticagrelor plus aspirin appeared to be cost-effective over 5-year and life-time projection periods compared to clopidogrel plus aspirin.
    VL  - 5
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia

  • School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia

  • School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia

  • Prince of Wales Hospital, Shatin, Hong Kong

  • School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia

  • Sections