Cost-effectiveness of prasugrel in a US managed care population

Abstract

Objective:

Decision-makers in the US may be interested in the applicability to their populations of cost-effectiveness results generated from clinical trial populations.

Methods:

An economic model estimating the cost-effectiveness of prasugrel plus aspirin relative to clopidogrel plus aspirin for patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) was developed from a managed care organization (MCO) perspective. The model estimated 15-month cardiovascular events or bleeding-related outcomes, life expectancy, and costs for patients who received thienopyridine treatment during and after a PCI following a diagnosis of ACS. Post-ACS event rates for patients treated with clopidogrel were from an MCO. The relative risks of these events with prasugrel compared with clopidogrel were from a head-to-head clinical trial.

Results:

The results of the base-case analysis indicated that, in an MCO population, use of prasugrel-based therapy rather than clopidogrel-based therapy at current prices resulted in cost-savings and fewer clinical events over the 15 months after an ACS diagnosis followed by PCI. At possible lower prices for generic clopidogrel-based therapy, the cost-effectiveness ratio for prasugrel-based therapy compared with clopidogrel-based therapy was between $6643 and $13,906 per life-year gained. The results were most sensitive to the relative costs of the two treatments and the cost for hospital stays.

Limitations:

Limitations of the study included lack of follow-up of patients disenrolling from the MCO before the end of the 15-month observation period, the assumption of equal relative risks of events in an MCO as in the clinical trial, and the lack of information on the ratio of cost to charges in the MCO database.

Conclusions:

Use of prasugrel-based therapy compared with clopidogrel-based therapy in ACS patients having a PCI resulted in cost-savings at current prices and favorable cost-effective ratios at likely generic prices for clopidogrel-based therapy because of offsetting savings in the costs of rehospitalization.

Keywords::

• Acute coronary syndromes
• Cost-effectiveness
• Managed care population
• Antiplatelet therapy
• Thienopyridine

Transparency

Declaration of funding

This study was funded by Eli Lilly & Company.

Declaration of financial/other relationships

Dr Mauskopf and Mr Graham are employees of RTI Health Solutions, an independent research organization that received consulting fees from Eli Lilly & Company for the development of this paper. Dr Meadows, Dr Bae, and Mr Zagar are employees of Eli Lilly & Company, the manufacturer of prasugrel. Dr Ramaswamy is an employee of Daiichi Sankyo Inc., a partner with Eli Lilly & Company in marketing prasugrel. Dr Magnuson and Dr Cohen are employees of St. Luke’s Hospital; they served as consultants for this study. Dr Cohen has received speaking honoraria from Eli Lilly & Company and Daiichi-Sankyo, Inc., manufacturers of prasugrel.

Acknowledgments

None.