Comparison of healthcare resource utilization and costs in patients hospitalized for acute coronary syndrome managed with percutaneous coronary intervention and receiving prasugrel or ticagrelor

Abstract

Objective:

To compare healthcare resource utilization (HCRU) and healthcare costs in patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with prasugrel or ticagrelor.

Methods:

Hospital charge master data were used to identify ACS-PCI patients aged ≥18 years with ≥1 in-hospital claim for prasugrel or ticagrelor between August 1, 2011–April 30, 2013. Treatment groups were propensity matched for baseline and index hospitalization characteristics. HCRU and costs were assessed through 90-days post-discharge. Costs were determined based on hospital-specific cost-to-charge ratios and adjusted to 2013 US dollars.

Results:

Before matching, ticagrelor patients were older, more-often female, and had increased cardiovascular (CV) and bleeding risks compared with prasugrel patients. Propensity-matched length of index hospital stay (4.7 vs 4.9 days, p = 0.23) and risk for all-cause [30-day: relative risk (RR) = 0.86; 95% CI = 0.73–1.0; 90-day: RR = 0.90; 95% CI = 0.80–1.0, and CV-related (30-day: RR = 0.77; 95% CI = 0.59–1.0; 90-day: RR = 0.89; 95% CI = 0.73–1.1) re-hospitalizations did not significantly differ between prasugrel and ticagrelor, respectively. Compared to ticagrelor, the propensity-matched risk of re-hospitalization for myocardial infarction (MI) (30-day: RR = 0.39; 95% CI = 0.21–0.75; 90-day: RR = 0.53; 95% CI = 0.34–0.81) and an outpatient medical encounter for dyspnea (30-day: RR = 0.49; 95% CI = 0.33–0.74; 90-day: RR = 0.60; 95% CI = 0.46–0.80) were significantly lower for prasugrel patients, with no significant differences in bleeding encounters between groups (30-day: RR = 0.87; 95% CI = 0.54–1.40; 90-day: RR = 1.0; 95% CI = 0.71–1.50). Matched total healthcare costs were not significantly different between groups during the index hospitalization ($36,011 vs $37,247, p = 0.21), 30-days post-discharge ($2007 vs $2522, p = 0.48), 90-days post-discharge ($4564 vs $5242, p = 0.49), and aggregate of the index hospitalization through 90-day follow-up ($40,576 vs $42,494, p = 0.09) timeframes.

Conclusions:

Re-hospitalization for MI and outpatient encounters for dyspnea were lower in prasugrel treated than in ticagrelor treated ACS-PCI patients up to 90-days post-index hospitalization discharge, with no difference in bleeding encounters or healthcare costs between the two populations. This data supports the utility of prasugrel in routine clinical practice. These findings should be considered within limitations of observational research.

Keywords::

• Acute coronary syndrome
• Prasugrel
• Ticagrelor
• Healthcare utilization
• Costs

Transparency

Declaration of funding

This study was funded by Daiichi Sankyo Inc., Parsippany, NJ, USA and Eli Lilly and Company, Indianapolis, IN, USA.

Declaration of financial/other relationships

CM, CL, YZ, PM, and MBE are employees of Eli Lilly and Company. FF and EM are employees of Daiichi Sankyo, Inc. GV is an unpaid consultant to Daiichi Sankyo and Eli Lilly. MD, SK, JL were employees of IMS Health at the time of the study. IMS Health received research funding from Daiichi Sankyo Inc. and Eli Lilly and Company to conduct this study and prepare this manuscript.

Acknowledgments

The authors thank Doug Faries, PhD, Hsiao Lieu, MD, William Malatestinic, PharmD, and Nayan Acharya, MD, at Eli Lilly and Company; Qiaoyi Zhang, PhD, Brian Baker, PharmD, and Howard Rutman, MD, at Daiichi Sankyo Inc.; and Won Chan Lee at IMS, for valuable contributions to this study and manuscript. Molly Tomlin, MS, at Eli Lilly and Company assisted in the preparation of this manuscript.

Previous presentation

Some material contained in this paper was previously presented at the American Heart Association: Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Scientific Sessions; Baltimore, MD, USA; June 2–4, 2014.