(233) Ticagrelor for Acute Coronary Disease to Prevent Cardiovascular Events: Cost-Effectiveness Analysis in Indonesia

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 907

Presenting Author(s)

Jarir At Thobari, MD
– Academic Staff, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, Indonesia

Co-Author(s)

Jonathan Hasian Haposan, MPH, MD
– Clinical Epidemiology & Biostatistics Unit (CEBU) Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia

Background: Cardiovascular diseases including acute coronary syndromes (ACS) are life-threatening diseases and are associated with significant health and economic burdens in Indonesia. The study PLATO showed that ACS patients who were randomized to receive 12 months of ticagrelor had a significant reduction in the combined CVD endpoint.

Objectives: The study objective was to evaluate the cost-effectiveness of ticagrelor in reducing CV endpoint in the Indonesia setting.

Methods: It used the Markov model as a decision analysis to compare ticagrelor with clopidogrel for ACS. The model constructed with a decision tree included four health conditions (no additional events, non-fatal myocardial infarction, non-fatal stroke, and any cause death), The probability of each state and quality-adjusted life years were derived from the PLATO trial and Indonesia life table. The resource consumption and associated costs were collected from three hospitals (public, national referral, and private hospitals) in Indonesia. The study was conducted from a health care provider perspective, using 5 years and lifetime horizon and discounting rate of 3%.

Results: The incremental QALYs and life-year gained (LYG) of ticagrelor in five years was 0.0410 and 0.0462, respectively; in a lifetime was 0.0828, and 0.0947, respectively. The ICER per QALY of ticagrelor versus clopidogrel in private, national referral, and public hospitals was USD 2390.276, USD 3813.638, USD 1278.361, respectively for five years; and USD 2471.392, USD 5453.987, USD 2343.269, respectively for a lifetime. The probability of ticagrelor being cost-effective was 66.6% on a five-year and 99.7% on a lifetime with WTP USD 3634.

Conclusions: QALYs and life-year gained of use ticagrelor higher compared to clopidogrel. The incremental cost-effectiveness ratio in five years and lifetime models showed under one-time GDP, which means the use of ticagrelor was highly cost-effective and acceptable to apply in the clinical setting in Indonesia.