Evidence map›Paper›PMID 35488865›Full record

Trial reportEuropean heart journal. Cardiovascular pharmacotherapy2022

Cost-effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease: a European economic evaluation of the THEMIS trial.

Philippe Gabriel Steg, Deepak L Bhatt, Stefan K James, Oliver Darlington, Louise Hoskin, Tabassome Simon, Kim M Fox, Lawrence A Leiter, Shamir R Mehta, Robert A Harrington and 8 more

Abstract readClinical Trial
In one paragraph

Trial report in European heart journal. Cardiovascular pharmacotherapy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 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

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Ticagrelor monotherapy versus ticagrelor plus aspirin in patients with chronic coronary syndrome and high ischaemic risk: a post hoc analysis of the TWILIGHT trial.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025
    Trial
  4. Article
  5. Article
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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

18 authors.

Philippe Gabriel StegUniversité de Paris, AP-HP, Hôpital Bichat, FACT (French Alliance for Cardiovascular trials) and INSERM-U1148, Paris, France.ORCID 0000-0001-6896-2941
Deepak L BhattDepartment of Medicine, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA 02115, USA.
Stefan K JamesDepartment of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, 752 37 Uppsala, Sweden.ORCID 0000-0003-4413-9736
Oliver DarlingtonHealth Economics and Outcomes Research Ltd, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff CF23 8RB, UK.
Louise HoskinHealth Economics and Outcomes Research Ltd, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff CF23 8RB, UK.
Tabassome SimonDepartment of Clinical Pharmacology, Hôpital Saint Antoine, Unité de Recherche Clinique, 75012 Paris, France.
Kim M FoxNational Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London SW3 6NP, UK.
Lawrence A LeiterLi Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1T8, Canada.
Shamir R MehtaHamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, ON L8S 4L8, Canada.
Robert A HarringtonDepartment of Medicine, Stanford University, Stanford, CA 94305, USA.
Anders HimmelmannBioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden.
Wilhelm RidderstråleBioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden.
Marielle AnderssonBioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden.
Héctor BuenoDepartment of Cardiology, Hospital Doce de Octubre, 28007 Madrid, Spain.
Leonardo De LucaDepartment of Cardiosciences, A.O. San Camillo-Forlanini, 00152 Rome, Italy.
Amarjeet TankAstraZeneca, Cambridge, CB2 8PA, UK.
Carl MellströmBioPharmaceuticals R&D, Cardiovascular, Renal and Metabolic, AstraZeneca, 431 50 Gothenburg, Sweden.
Phil McEwanHealth Economics and Outcomes Research Ltd, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff CF23 8RB, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo 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

resultsA 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 [€47 000/quality-adjusted life-year (QALY) in Sweden and €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 €27 894 and €42 252/QALY across Sweden, Germany, Italy, and Spain in the overall population. In patients with prior PCI, estimated ICERs improved to €18 449, €20 632, €20 233, and €13 228/QALY in Sweden, Germany, Italy, and Spain, respectively, driven by higher event rates and treatment benefit.

conclusionBased 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.

Indexed as

Diabetes Mellitus, Type 2TicagrelorAspirinCoronary Artery DiseaseCost-Benefit AnalysisHumansPercutaneous Coronary InterventionAspirinTicagrelorCoronary artery diseaseCost–effectivenessPercutaneous coronary interventionTicagrelorType 2 diabetes

Identifiers

PMID35488865
PMCPMC9716869

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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.