AstraZeneca announced last week that full data results of the PLATO health economics substudy, which have been published online in the European Heart Journal, demonstrate that even at a higher drug cost and incremental cost per acute coronary syndromes (ACS) patient, ticagrelor (known as BRILIQUE in the European Union and BRILINTA elsewhere) numerically lowered non-drug healthcare costs versus generic clopidogrel and is cost-effective.

The cost-effectiveness of ticagrelor was driven by the mortality benefit seen in the pivotal PLATO trial, which showed ticagrelor was cost-effective across all major patient subgroups.

The analysis used in the health economics substudy included the Swedish costs for both ticagrelor and generic clopidogrel and found that though treating ACS patients with ticagrelor costs an additional average of €96 per patient/year, treatment with ticagrelor resulted in a 21% mortality benefit and lower healthcare costs at 12 months as compared to generic clopidogrel.

"What's striking about these data is that they showed treatment with ticagrelor was cost- effective for ACS patients, compared to the lower-priced generic option, because the medicine improved survival, reduced recurrent events and reduced other healthcare costs," said Lars Wallentin, Professor Cardiology Uppsala Clinical Research Centre.

An initial analysis from the PLATO HECON substudy on resource utilization and cost was first presented in November 2010 at the American Heart Association annual meeting in an abstract presentation called, Health Economics in the PLATelet inhibition and patient Outcomes (PLATO) Randomised Trial: Report on Within Trial Resource Use Patterns. This analysis excluded drug costs and concomitant drugs and did not account for the mortality data.

Following was a presentation at the 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) annual meeting that showed the overall cost impact of using ticagrelor instead of generic clopidogrel was cost-effective. The newly published data set included cardiovascular events, costs and quality-of-life data, drug costs and long-term data in the analyses and assessed the long-term cost-effectiveness of treating ACS patients for 12 months with ticagrelor and aspirin according to the EU label. In the analysis, ticagrelor was associated with a quality-adjusted life year (QALY) gain of 0.1316 at a lifetime incremental cost of €362, yielding a cost per QALY gained as compared to clopidogrel of €2,372.

Cost per QALY is an important measure used by national governments and their reimbursement agencies to assess cost-effectiveness of medical treatments. In order to prioritise treatments, the long-term costs and health outcomes of different treatment strategies are assessed and compared. While no universal threshold for cost-effectiveness exists, generally, a cost per QALY in the range of €25,000 ($33,000) to €38,000 ($50,000) is considered cost-effective.

The PLATO health economics data is part of a prospectively designed substudy of PLATO designed to help address important questions related to the access and affordability of ticagrelor around the world. To date, ticagrelor has received positive reimbursement recommendations in 25 countries, including European markets such as the UK, Germany and Italy.

Source: AstraZeneca