Volume 5, Issue 3, September 2020, Page: 63-71
Economic Evaluation of Ticagrelor in Treating Patients with Acute Coronary Syndrome in Hong Kong: A Cost-Utility Analysis
David Bin-Chia Wu, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
June Wai Yee Choon, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Chun Wie Chong, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Benjamin Shing Cheung Lee, Prince of Wales Hospital, Shatin, Hong Kong
Kenneth Kwing Chin Lee, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Received: Sep. 8, 2020;       Accepted: Oct. 6, 2020;       Published: Oct. 17, 2020
DOI: 10.11648/j.hep.20200503.13      View  94      Downloads  31
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.
Keywords
Ticagrelor, Acute Coronary Syndrome, Health Utility Analysis, Simulation Model, Cost Per QALY
To cite this article
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, International Journal of Health Economics and Policy. Vol. 5, No. 3, 2020, pp. 63-71. doi: 10.11648/j.hep.20200503.13
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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