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Steg PG, Bhatt DL, James SK, Darlington O, Hoskin L, Simon T, Fox KM, Leiter LA, Mehta SR, Harrington RA, Himmelmann A, Ridderstråle W, Andersson M, Bueno H, De Luca L, Tank A, Mellström C, McEwan P. Cost-effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease: a European economic evaluation of the THEMIS trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:777-785. [PMID: 35488865 PMCID: PMC9716869 DOI: 10.1093/ehjcvp/pvac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 12/29/2022]
Abstract
AIMS To conduct a health economic evaluation of ticagrelor in patients with type 2 diabetes and coronary artery disease (CAD) from a multinational payer perspective. Cost-effectiveness and cost-utility of ticagrelor were evaluated in the overall effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study (THEMIS) trial population and in the predefined patient group with prior percutaneous coronary intervention. METHODS AND RESULTS A Markov model was developed to extrapolate patient outcomes over a lifetime horizon. The primary outcome was incremental cost-effectiveness ratios (ICERs), which were compared with conventional willingness-to-pay thresholds [€47 000/quality-adjusted life-year (QALY) in Sweden and €30 000/QALY in other countries].Treatment with ticagrelor resulted in QALY gains of up to 0.045 in the overall population and 0.099 in patients with percutaneous coronary intervention (PCI). Increased costs and benefits translated to ICERs ranged between €27 894 and €42 252/QALY across Sweden, Germany, Italy, and Spain in the overall population. In patients with prior PCI, estimated ICERs improved to €18 449, €20 632, €20 233, and €13 228/QALY in Sweden, Germany, Italy, and Spain, respectively, driven by higher event rates and treatment benefit. CONCLUSION Based on THEMIS results, ticagrelor plus aspirin compared with aspirin alone may be cost-effective in some European countries in patients with T2DM and CAD and no prior myocardial infarction (MI) or stroke. Additionally, ticagrelor is likely to be cost-effective across European countries in patients with a history of PCI.
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Affiliation(s)
- Philippe Gabriel Steg
- Université de Paris, AP-HP, Hôpital Bichat, FACT (French Alliance for Cardiovascular trials) and INSERM-U1148, Paris, France
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA 02115, USA
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, 752 37 Uppsala, Sweden
| | - Oliver Darlington
- Health Economics and Outcomes Research Ltd, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff CF23 8RB, UK
| | - Louise Hoskin
- Health Economics and Outcomes Research Ltd, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff CF23 8RB, UK
| | - Tabassome Simon
- Department of Clinical Pharmacology, Hôpital Saint Antoine, Unité de Recherche Clinique, 75012 Paris, France
| | - Kim M Fox
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London SW3 6NP, UK
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1T8, Canada
| | - Shamir R Mehta
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, ON L8S 4L8, Canada
| | | | - Anders Himmelmann
- BioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden
| | - Wilhelm Ridderstråle
- BioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden
| | - Marielle Andersson
- BioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden
| | - Héctor Bueno
- Department of Cardiology, Hospital Doce de Octubre,28007 Madrid, Spain,MTCR Group, Centro Nacional de Investigaciones Cardiovasculares, 28029 Madrid, Spain
| | - Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini, 00152 Rome, Italy
| | | | - Carl Mellström
- BioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden
| | - Phil McEwan
- Corresponding author. Tel: +44 (0) 2920 399146,
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