Ticagrelor Treatment for Prevention of Cardiovascular Events in High Risk Post Myocardial Infarction Patients: Cost-Effectiveness Analysis Using Evidence From The Pegasus-Timi 54 Trial

The randomized, double-blind PEGASUS-TIMI 54 trial (NCT01225562) recruited 21,162 patients with a history of myocardial infarction (1 to 3 years prior) and at least one additional atherothrombotic risk factor. The trial demonstrated that ticagrelor on a background of low dose aspirin (ASA) reduced the risk of cardiovascular (CV) death, MI or stroke while the risk of TIMI major bleedings was increased compared with placebo. We report the cost-effectiveness of 3 years treatment for secondary prevention with ticagrelor 60mg BID compared with standard care from the healthcare perspectives of Denmark, Norway and Sweden. A decision analytic model was developed to incorporate risk equations of CV death, non-fatal MI or non-fatal stroke based on competing risks analysis, and appropriate statistical models to estimate hospitalisation rates and the health-related quality of life impact of clinical events. The clinical and economic analyses employed individual patient data from PEGASUS-TIMI 54. Country specific healthcare costs and background mortality rates were applied. Long-term incremental cost-effectiveness is estimated based on extrapolation of healthcare costs and quality adjusted life years (QALYs) over a lifetime horizon. Ticagrelor 60mg BID + ASA reduced the incidence of cardiovascular death, MI or stroke but increased TIMI bleeds and dyspnoea events. The model predicted overall incremental health benefits of approximately 0.05 QALYs gained, at incremental costs of €2,000-3,000 per patient. Cost per QALY was €26,000 (Sweden), €30,000 (Norway) and €32,000 (Denmark), within the commonly accepted cost-effectiveness thresholds for each of these countries. In post MI patients at high risk of further atherothrombotic events, secondary prevention with ticagrelor 60mg BID plus ASA can be considered a cost-effective treatment option from the healthcare perspectives of Scandinavian countries.