학술논문
Cost--effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease: a European economic evaluation of the THEMIS trial
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Academic Journal
Author
Steg, Philippe Gabriel; Bhatt, Deepak L.; K.James, Stefan; Darlington, Oliver; Hoskin, Louise; Simon, Tabassome; Fox, Kim M.; Leiter, Lawrence A.; m, Shamir R. Mehta; Harrington, Robert A.; Himmelmann, Anders; Ridderstrale, Wilhelm; Andersson, Marielle; Bueno, Hector; Luca, Leonardo De; Tank, Amarjeet; Mellstrom, Carl; McEwan, Phil
Source
European Heart Journal: Cardiovascular Pharmacotherapy. December 2022, Vol. 8 Issue 5, p777, 9 p.
Subject
Language
English
ISSN
2055-6837
Abstract
Introduction Type 2 diabetes mellitus (T2DM) had an estimated global prevalence of ~500 million in 2019. (1) T2DM is associated with an increased risk of vascular disease, with around one [...]
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 [[euro]47 000/quality-adjusted life-year (QALY) in Sweden and [euro]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 [euro]27 894 and [euro]42 252/QALY across Sweden, Germany, Italy, and Spain in the overall population. In patients with prior PCI, estimated ICERs improved to [euro]18 449, [euro]20 632, [euro]20 233, and [euro]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. Keywords Coronary artery disease * Cost--effectiveness * Percutaneous coronary intervention * Ticagrelor * Type 2 diabetes
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 [[euro]47 000/quality-adjusted life-year (QALY) in Sweden and [euro]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 [euro]27 894 and [euro]42 252/QALY across Sweden, Germany, Italy, and Spain in the overall population. In patients with prior PCI, estimated ICERs improved to [euro]18 449, [euro]20 632, [euro]20 233, and [euro]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. Keywords Coronary artery disease * Cost--effectiveness * Percutaneous coronary intervention * Ticagrelor * Type 2 diabetes