CHICAGO – Acute coronary syndrome patients randomized to dual antiplatelet therapy with ticagrelor and aspirin had fewer hospital bed days, revascularization procedures, and total health care costs over the course of 1 year, compared with patients assigned to clopidogrel plus aspirin, according to an economic substudy of the Platelet Inhibition and Patient Outcomes trial.
Mean 1-year total health care costs, excluding the cost of the drugs, were $18,666 in the clopidogrel (Plavix) arm and $17,988 with ticagrelor (Brilinta), an investigational, reversibly binding, oral P2Y12 receptor antagonist, based on Swedish costs per resource used. The resultant mean $678 savings in the ticagrelor group was significant, Dr. Magnus Janzon said at the annual scientific sessions of the American Heart Association.
The Platelet Inhibition and Patient Outcomes (PLATO) trial was a 43-country, double-blind randomized trial of 18,624 patients with acute coronary syndrome. The previously reported primary composite study end point consisting of MI, stroke, or death due to vascular causes occurred in 9.8% of patients in the ticagrelor arm and 11.7% with clopidogrel, for a significant 16% relative risk reduction favoring the newer agent (N. Engl. J. Med. 2009;361:1045-57). This benefit came without any significant cost in terms of major bleeding rates, which were similar in the two treatment arms, noted Dr. Janzon, head of cardiology at Linkoping (Sweden) University Hospital.
The economic substudy included the 10,686 PLATO participants with detailed 1-year follow-up data. During that time frame, the ticagrelor group collectively had 1,149 fewer hospital bed days, including 333 fewer days in the intensive care unit and 379 fewer days in the coronary care unit. The ticagrelor group also had 95 fewer percutaneous coronary interventions and 41 fewer coronary artery bypass graft procedures.
Because health care costs vary so widely from country to country, Dr. Janzon and his colleagues also calculated the 1-year mean total costs using U.S. values, which were nearly twice as high as in Sweden: $34,938 in the ticagrelor plus aspirin group, compared with $33,961 for clopidogrel plus aspirin, for a $977 reduction per patient in the ticagrelor arm.
In December the Food and Drug Administration declined to approve ticagrelor, and requested additional analyses of PLATO despite an earlier 7-1 vote in favor of approval by the FDA’s Cardiovascular and Renal Drugs Advisory Committee.
The PLATO trial was sponsored by AstraZeneca. Dr. Janzon declared having no relevant financial interests.