Purpose. Clinical practice variations and low implementation of effective and cost-effective heal... more Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (£22,300) per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.
Pacing and Clinical Electrophysiology, Oct 1, 2009
Background: Living with paroxysmal supraventricular tachycardia affects a patient's whole life si... more Background: Living with paroxysmal supraventricular tachycardia affects a patient's whole life situation, but few studies have addressed health-related quality of life (HRQOL) aspects in these patients. The aim was therefore to describe HRQOL in patients with atrioventricular nodal re-entry tachycardia (AVNRT) or Wolff-Parkinson-White (WPW) syndrome, referred for radiofrequency ablation (RF-ablation), compared to age-and gender-matched Swedish reference groups. Methods: HRQOL was assessed with SF-36 and EuroQol (EQ-5D and EQ-VAS) and the patients were asked disease-specific questions. Results: The 97 patients with AVNRT [53 ± 16 years of age/65 women] and 79 patients with WPW [42 ± 15 years of age/26 women] exhibited significantly lower HRQOL scores in SF-36 in the same seven of the eight scales: Physical functioning (PF), role-physical (RP), social functioning (SF), role-emotional (RE), general health (GH), vitality (VT), and mental health (MH) while there was no difference in bodily pain (BP) compared to their respective age-and gender matched Swedish reference group. HRQOL scores were lower for patients with AVNRT compared to WPW in the areas of PF (
Aims The utilization and timing of revascularization in unstable coronary artery disease varies, ... more Aims The utilization and timing of revascularization in unstable coronary artery disease varies, which could have important consequences for patients and for treatment costs. The FRISC II invasive trial compared an early invasive strategy vs a non-invasive strategy with respect to the composite end-point of death and myocardial infarction as well as costs. Methods and Results A total of 2457 patients, median age 66 years, comprising 70% men, were randomized. We prospectively recorded the patients' use of the health service. The results were analysed in a societal perspective. There was a significant 1•7% absolute reduction in deaths and a 3•7% absolute reduction in deaths and myocardial infarctions in the invasive compared to the non-invasive group after 12 months. During the initial hospitalization a patient in the invasive group spent on average 3•9 more days in hospital than a patient in the non-invasive group. Opposite results were found for rehospitalizations. The difference in mean total costs is SEK 23 876 (P<0•001). The incremental cost-effectiveness ratio for choosing the invasive instead of the non-invasive strategy is SEK 1 404 000 per avoided death and SEK 645 000 per avoided death or myocardial infarction. Conclusion The high cost at the beginning of the invasive strategy is substantial. The clinical results of the FRISC II study provided evidence that the invasive strategy reduces the rate of death and myocardial infarction in patients with unstable coronary artery disease. For policy discussions concerning whether or not to implement the invasive strategy, these positive results should be balanced against the cost-consequences of the strategy.
Health Economics in the PLATelet Inhibition and Patient Outcomes (PLATO) Randomized Trial: Report... more Health Economics in the PLATelet Inhibition and Patient Outcomes (PLATO) Randomized Trial: Report on Within Trial Resource Use Patterns
Journal of the American Heart Association, Mar 7, 2023
Background Effectiveness estimates from observational studies on ticagrelor use in routine clinic... more Background Effectiveness estimates from observational studies on ticagrelor use in routine clinical care are conflicting, with some contrary to the results of the pivotal randomized controlled trial of ticagrelor in acute coronary syndrome. The aim of this study was to estimate the effect of implementing and using ticagrelor in routine clinical care in patients with myocardial infarction using a natural experimental approach. Methods and Results This is a retrospective cohort study including patients hospitalized for myocardial infarction in Sweden between 2009 and 2015. The study exploited differences in the timing and speed of ticagrelor implementation between treatment centers as a source of random treatment assignment. The effect of implementing and using ticagrelor was estimated based on the admitting center's likelihood of treating patients with ticagrelor, measured as the proportion of patients treated in the 90 days before patient admission. The main outcome was 12‐month mortality. The study included 109 955 patients, of whom 30 773 were treated with ticagrelor. Being admitted to a treatment center with higher past ticagrelor use was associated with a reduction in 12‐month mortality (2.5 percentage points for 100% versus 0% past use [95% CI, 0.2–4.8]). The results are in line with the findings from the ticagrelor pivotal trial. Conclusions Using a natural experiment, this study finds that the implementation and use of ticagrelor in routine clinical care has reduced 12‐month mortality in patients admitted to the hospital with myocardial infarction in Sweden and supports the external validity of randomized evidence on ticagrelor effectiveness.
Journal of the American College of Cardiology, 2000
Cast-comparison of early invasive versus non-invasive treatment in unstable coronary artery disea... more Cast-comparison of early invasive versus non-invasive treatment in unstable coronary artery disease - A six months follow-up from the FRISC II invasive trial
Cost and effectiveness comparison of very early treatment with primary percutaneous coronary inte... more Cost and effectiveness comparison of very early treatment with primary percutaneous coronary intervention facilitated with abciximab or thrombolytic therapy for acute ST-elevation myocardial infarction
Rapid Fire-Understanding the diversity of ACS / Catheter ablation of atrial fibrillation: have we... more Rapid Fire-Understanding the diversity of ACS / Catheter ablation of atrial fibrillation: have we met expectations? 649 comparing Cilostazol, a selective inhibitor of phosphodiesterase 3, with placebo, on top of standard amlodipine therapy, in patients with vasospastic angina. Background: Cilostazol has a potent vasodilator effect, but its impact on vasospastic angina is unknown. Methods: Between October 2011 and July 2012, 50 patients with confirmed vasospastic angina who have ≥ 1 angina episodes/week despite amlodipine therapy (5mg/day) for 2 weeks were randomly assigned to receive either Cilostazol (100mg/day) or placebo for 2 weeks followed by Cilostazol (200mg/day) or placebo for 2 weeks in 10 hospitals in Korea. All patients were given diaries to record the angina episode and severity of angina (0-10 grading). Primary endpoint was percent change in weekly angina episodes defined as (number of angina at baseline week-number of angina at last week)/(number of angina at baseline week)×100. Findings: The data of forty nine patients (25 in Cilostazol, 24 in placebo) were analysed for the study. Baseline characteristics were similar between the two groups. At 4-week follow-up, primary endpoint was significantly greater in the Cilostazol group compared with the placebo group (-66.5±88.6% vs.-17.6±140.1%, respectively, p=0.009). Secondary endpoints including change in the weekly angina episode (-3.7±0.5 vs.-1.9±0.6, respectively, p=0.029), change in angina severity scale (-2.8±0.4 vs.-1.1±0.4, respectively, p=0.003), proportion of angina free patients (76.0% vs. 33.3%, respectively, p=0.003) were in favor of Cilostazol. Headache was the most common adverse event (40.0% vs. 20.8%, respectively, p=0.22). Conclusion: Cilostazol was effective in treating vasospastic angina that is unresponsive to the standard calcium antagonist. Cilostazol might be considered as an add-on therapy for patients with refractory vasospastic angina
Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-r... more Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden
Primary PCI Performed With Delay > 90 Minutes From Diagnosis Seems Acceptable in Terms of Shor... more Primary PCI Performed With Delay > 90 Minutes From Diagnosis Seems Acceptable in Terms of Short- and Long-Term Clinical Outcome. One Year Results From EUROTRANSFER Registry,Washington DC, USA
During the past few decades two treatment strategies have evolved for patients with unstable coro... more During the past few decades two treatment strategies have evolved for patients with unstable coronary artery disease (UCAD). The non-invasive strategy uses clinical investigations and non-invasive ...
Objective To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with... more Objective To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management. Methods A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and healthrelated quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems. Results Ticagrelor was associated with lifetime qualityadjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability. Conclusions Treatment of patients with ACS scheduled for 12 months' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel. Trial registration number NCT000391872.
Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI... more Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. Methods Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. Results Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group
The efficacy and safety of ticagrelor vs. clopidogrel in patients with acute coronary syndromes (... more The efficacy and safety of ticagrelor vs. clopidogrel in patients with acute coronary syndromes (ACS) are well documented in the PLATelet inhibition and patient Outcomes trial (PLATO). The aim of this study was to assess the longterm cost-effectiveness of treating ACS patients for 12 months with ticagrelor compared with generic clopidogrel. Methods and results Event rates, health-care costs, and health-related quality of life during 12 months of therapy with either ticagrelor or generic clopidogrel were estimated from PLATO. Beyond 12 months, quality-adjusted survival and costs were estimated conditional on whether a non-fatal myocardial infarction (MI), a non-fatal stroke, or no MI or stroke occurred during the 12 months of therapy. Lifetime costs, life expectancy, and quality-adjusted life years (QALYs) were estimated for both treatment strategies. Incremental cost-effectiveness ratios were presented from a healthcare perspective in 2010 Euros (E) applying unit costs and life tables from a Swedish setting in the base-case analysis. Treatment with ticagrelor was associated with increased health-care costs of E362 and a QALY gain of 0.13 compared with generic clopidogrel, yielding a cost per QALY gained with ticagrelor of E2753. The cost per life year gained was E2372. The results were consistent in major subgroups. Sensitivity analyses showed a cost per QALY gained with ticagrelor of E7300 under certain scenarios. Conclusion Based on clinical and health-economic evidence from the PLATO study, treating ACS patients with ticagrelor for 12 months is associated with a cost per QALY below generally accepted thresholds for cost-effectiveness. ClinicalTrials.gov Identifier: NCT00391872.
Purpose. Clinical practice variations and low implementation of effective and cost-effective heal... more Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (£22,300) per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.
Pacing and Clinical Electrophysiology, Oct 1, 2009
Background: Living with paroxysmal supraventricular tachycardia affects a patient's whole life si... more Background: Living with paroxysmal supraventricular tachycardia affects a patient's whole life situation, but few studies have addressed health-related quality of life (HRQOL) aspects in these patients. The aim was therefore to describe HRQOL in patients with atrioventricular nodal re-entry tachycardia (AVNRT) or Wolff-Parkinson-White (WPW) syndrome, referred for radiofrequency ablation (RF-ablation), compared to age-and gender-matched Swedish reference groups. Methods: HRQOL was assessed with SF-36 and EuroQol (EQ-5D and EQ-VAS) and the patients were asked disease-specific questions. Results: The 97 patients with AVNRT [53 ± 16 years of age/65 women] and 79 patients with WPW [42 ± 15 years of age/26 women] exhibited significantly lower HRQOL scores in SF-36 in the same seven of the eight scales: Physical functioning (PF), role-physical (RP), social functioning (SF), role-emotional (RE), general health (GH), vitality (VT), and mental health (MH) while there was no difference in bodily pain (BP) compared to their respective age-and gender matched Swedish reference group. HRQOL scores were lower for patients with AVNRT compared to WPW in the areas of PF (
Aims The utilization and timing of revascularization in unstable coronary artery disease varies, ... more Aims The utilization and timing of revascularization in unstable coronary artery disease varies, which could have important consequences for patients and for treatment costs. The FRISC II invasive trial compared an early invasive strategy vs a non-invasive strategy with respect to the composite end-point of death and myocardial infarction as well as costs. Methods and Results A total of 2457 patients, median age 66 years, comprising 70% men, were randomized. We prospectively recorded the patients' use of the health service. The results were analysed in a societal perspective. There was a significant 1•7% absolute reduction in deaths and a 3•7% absolute reduction in deaths and myocardial infarctions in the invasive compared to the non-invasive group after 12 months. During the initial hospitalization a patient in the invasive group spent on average 3•9 more days in hospital than a patient in the non-invasive group. Opposite results were found for rehospitalizations. The difference in mean total costs is SEK 23 876 (P<0•001). The incremental cost-effectiveness ratio for choosing the invasive instead of the non-invasive strategy is SEK 1 404 000 per avoided death and SEK 645 000 per avoided death or myocardial infarction. Conclusion The high cost at the beginning of the invasive strategy is substantial. The clinical results of the FRISC II study provided evidence that the invasive strategy reduces the rate of death and myocardial infarction in patients with unstable coronary artery disease. For policy discussions concerning whether or not to implement the invasive strategy, these positive results should be balanced against the cost-consequences of the strategy.
Health Economics in the PLATelet Inhibition and Patient Outcomes (PLATO) Randomized Trial: Report... more Health Economics in the PLATelet Inhibition and Patient Outcomes (PLATO) Randomized Trial: Report on Within Trial Resource Use Patterns
Journal of the American Heart Association, Mar 7, 2023
Background Effectiveness estimates from observational studies on ticagrelor use in routine clinic... more Background Effectiveness estimates from observational studies on ticagrelor use in routine clinical care are conflicting, with some contrary to the results of the pivotal randomized controlled trial of ticagrelor in acute coronary syndrome. The aim of this study was to estimate the effect of implementing and using ticagrelor in routine clinical care in patients with myocardial infarction using a natural experimental approach. Methods and Results This is a retrospective cohort study including patients hospitalized for myocardial infarction in Sweden between 2009 and 2015. The study exploited differences in the timing and speed of ticagrelor implementation between treatment centers as a source of random treatment assignment. The effect of implementing and using ticagrelor was estimated based on the admitting center's likelihood of treating patients with ticagrelor, measured as the proportion of patients treated in the 90 days before patient admission. The main outcome was 12‐month mortality. The study included 109 955 patients, of whom 30 773 were treated with ticagrelor. Being admitted to a treatment center with higher past ticagrelor use was associated with a reduction in 12‐month mortality (2.5 percentage points for 100% versus 0% past use [95% CI, 0.2–4.8]). The results are in line with the findings from the ticagrelor pivotal trial. Conclusions Using a natural experiment, this study finds that the implementation and use of ticagrelor in routine clinical care has reduced 12‐month mortality in patients admitted to the hospital with myocardial infarction in Sweden and supports the external validity of randomized evidence on ticagrelor effectiveness.
Journal of the American College of Cardiology, 2000
Cast-comparison of early invasive versus non-invasive treatment in unstable coronary artery disea... more Cast-comparison of early invasive versus non-invasive treatment in unstable coronary artery disease - A six months follow-up from the FRISC II invasive trial
Cost and effectiveness comparison of very early treatment with primary percutaneous coronary inte... more Cost and effectiveness comparison of very early treatment with primary percutaneous coronary intervention facilitated with abciximab or thrombolytic therapy for acute ST-elevation myocardial infarction
Rapid Fire-Understanding the diversity of ACS / Catheter ablation of atrial fibrillation: have we... more Rapid Fire-Understanding the diversity of ACS / Catheter ablation of atrial fibrillation: have we met expectations? 649 comparing Cilostazol, a selective inhibitor of phosphodiesterase 3, with placebo, on top of standard amlodipine therapy, in patients with vasospastic angina. Background: Cilostazol has a potent vasodilator effect, but its impact on vasospastic angina is unknown. Methods: Between October 2011 and July 2012, 50 patients with confirmed vasospastic angina who have ≥ 1 angina episodes/week despite amlodipine therapy (5mg/day) for 2 weeks were randomly assigned to receive either Cilostazol (100mg/day) or placebo for 2 weeks followed by Cilostazol (200mg/day) or placebo for 2 weeks in 10 hospitals in Korea. All patients were given diaries to record the angina episode and severity of angina (0-10 grading). Primary endpoint was percent change in weekly angina episodes defined as (number of angina at baseline week-number of angina at last week)/(number of angina at baseline week)×100. Findings: The data of forty nine patients (25 in Cilostazol, 24 in placebo) were analysed for the study. Baseline characteristics were similar between the two groups. At 4-week follow-up, primary endpoint was significantly greater in the Cilostazol group compared with the placebo group (-66.5±88.6% vs.-17.6±140.1%, respectively, p=0.009). Secondary endpoints including change in the weekly angina episode (-3.7±0.5 vs.-1.9±0.6, respectively, p=0.029), change in angina severity scale (-2.8±0.4 vs.-1.1±0.4, respectively, p=0.003), proportion of angina free patients (76.0% vs. 33.3%, respectively, p=0.003) were in favor of Cilostazol. Headache was the most common adverse event (40.0% vs. 20.8%, respectively, p=0.22). Conclusion: Cilostazol was effective in treating vasospastic angina that is unresponsive to the standard calcium antagonist. Cilostazol might be considered as an add-on therapy for patients with refractory vasospastic angina
Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-r... more Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden
Primary PCI Performed With Delay > 90 Minutes From Diagnosis Seems Acceptable in Terms of Shor... more Primary PCI Performed With Delay > 90 Minutes From Diagnosis Seems Acceptable in Terms of Short- and Long-Term Clinical Outcome. One Year Results From EUROTRANSFER Registry,Washington DC, USA
During the past few decades two treatment strategies have evolved for patients with unstable coro... more During the past few decades two treatment strategies have evolved for patients with unstable coronary artery disease (UCAD). The non-invasive strategy uses clinical investigations and non-invasive ...
Objective To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with... more Objective To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management. Methods A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and healthrelated quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems. Results Ticagrelor was associated with lifetime qualityadjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability. Conclusions Treatment of patients with ACS scheduled for 12 months' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel. Trial registration number NCT000391872.
Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI... more Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. Methods Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. Results Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group
The efficacy and safety of ticagrelor vs. clopidogrel in patients with acute coronary syndromes (... more The efficacy and safety of ticagrelor vs. clopidogrel in patients with acute coronary syndromes (ACS) are well documented in the PLATelet inhibition and patient Outcomes trial (PLATO). The aim of this study was to assess the longterm cost-effectiveness of treating ACS patients for 12 months with ticagrelor compared with generic clopidogrel. Methods and results Event rates, health-care costs, and health-related quality of life during 12 months of therapy with either ticagrelor or generic clopidogrel were estimated from PLATO. Beyond 12 months, quality-adjusted survival and costs were estimated conditional on whether a non-fatal myocardial infarction (MI), a non-fatal stroke, or no MI or stroke occurred during the 12 months of therapy. Lifetime costs, life expectancy, and quality-adjusted life years (QALYs) were estimated for both treatment strategies. Incremental cost-effectiveness ratios were presented from a healthcare perspective in 2010 Euros (E) applying unit costs and life tables from a Swedish setting in the base-case analysis. Treatment with ticagrelor was associated with increased health-care costs of E362 and a QALY gain of 0.13 compared with generic clopidogrel, yielding a cost per QALY gained with ticagrelor of E2753. The cost per life year gained was E2372. The results were consistent in major subgroups. Sensitivity analyses showed a cost per QALY gained with ticagrelor of E7300 under certain scenarios. Conclusion Based on clinical and health-economic evidence from the PLATO study, treating ACS patients with ticagrelor for 12 months is associated with a cost per QALY below generally accepted thresholds for cost-effectiveness. ClinicalTrials.gov Identifier: NCT00391872.
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