Evidence map›Paper›PMID 21669373›Full record

ArticleValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research2011

Ticagrelor versus genotype-driven antiplatelet therapy for secondary prevention after acute coronary syndrome: a cost-effectiveness analysis.

Daniel J Crespin, Jerome J Federspiel, Andrea K Biddle, Daniel E Jonas, Joseph S Rossi

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  3. Systematic review of the evidence on the cost-effectiveness of pharmacogenomics-guided treatment for cardiovascular diseases.Genetics in medicine : official journal of the American College of Medical Genetics · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Daniel J CrespinDepartment of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA.
Jerome J Federspiel
Andrea K Biddle
Daniel E Jonas
Joseph S Rossi

Funding

MEDICAL SCIENTIST TRAINING PROGRAMT32GM008719 · NIGMS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI DARVILLE, TONI, DESHMUKH, MOHANISH P · 1999 to 2023
$15.1M
Acute Coronary Syndrome Outcomes for Medicare PatientsR01AG025801 · NIA · UNIV OF NORTH CAROLINA CHAPEL HILL · PI STEARNS, SALLY C · 2007 to 2009
$794k
Impacts of Cost Sharing and Echocardiography on Outpatient Care of Heart FailureF30HL110483 · NHLBI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI FEDERSPIEL, JEROME JEFFREY · 2011 to 2014
$133k
NHLBI NIH HHS F30 HL110483NIA NIH HHS 5R01AG025801-03NIA NIH HHS R01 AG025801NIGMS NIH HHS 2T32GM008719-11NIGMS NIH HHS T32 GM008719
6 · The paper itself

Abstract

backgroundClopidogrel's effectiveness is likely reduced significantly for prevention of thrombotic events after acute coronary syndrome (ACS) in patients exhibiting a decreased ability to metabolize clopidogrel into its active form. A genetic mutation responsible for this reduced effectiveness is detectable by genotyping. Ticagrelor is not dependent on gene-based metabolic activation and demonstrated greater clinical efficacy than clopidogrel in a recent secondary prevention trial. In 2011, clopidogrel will lose its patent protection and likely will be substantially less expensive than ticagrelor.

objectiveTo determine the cost-effectiveness of ticagrelor compared with a genotype-driven selection of antiplatelet agents.

methodsA hybrid decision tree/Markov model was used to estimate the 5-year medical costs (in 2009 US$) and outcomes for a cohort of ACS patients enrolled in Medicare receiving either genotype-driven or ticagrelor-only treatment. Outcomes included life years and quality-adjusted life years (QALYs) gained. Data comparing the clinical performance of ticagrelor and clopidogrel were derived from the Platelet Inhibition and Patient Outcomes trial.

resultsThe incremental cost-effectiveness ratio (ICER) for universal ticagrelor was $10,059 per QALY compared to genotype-driven treatment, and was most sensitive to the price of ticagrelor and the hazard ratio for death for ticagrelor compared with clopidogrel. The ICER remained below $50,000 per QALY until a monthly ticagrelor price of $693 or a 0.93 hazard ratio for death for ticagrelor relative to clopidogrel. In probabilistic analyses, universal ticagrelor was below $50,000 per QALY in 97.7% of simulations.

conclusionPrescribing ticagrelor universally increases quality-adjusted life years for ACS patients at a cost below a typically accepted threshold.

Indexed as

Acute Coronary SyndromeAdenosineAgedAged, 80 and overCost-Benefit AnalysisGenotypeHumansMarkov ChainsMedicarePlatelet Aggregation InhibitorsSecondary PreventionTicagrelorUnited StatesAdenosinePlatelet Aggregation InhibitorsTicagrelor

Identifiers

PMID21669373
PMCPMC3384486

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.