Cost Utility of Prasugrel in Postangioplasty Diabetic Patients
Cost Utility of Prasugrel in Postangioplasty Diabetic Patients
Data
2022
Autores
Padilla, Matheus Piccin
Macedo, Luana Schroeder Damico Nascimento
França, Ana Cláudia Wekmuller
Meirelles, Isandra
Magliano, Carlos Alberto da Silva
Santos, Marisa da Silva
Journal Title
Journal ISSN
Volume Title
Publisher
Value in Health regional Issues
Resumo
Objectives: To prevent thrombotic events after angioplasty, current guidelines recommend dual antiplatelet therapy with
aspirin and thienopyridine. Clopidogrel is the only thienopyridine currently available in the Brazilian National Health System.
The purpose of this study was to determine the cost-effectiveness of prasugrel, an alternative thienopyridine, compared with
clopidogrel in patients with acute coronary syndrome and diabetes mellitus who underwent angioplasty.
Methods: A state-transition Markov model was created to simulate the progression of diabetic patients after angioplasty. The
model had a lifetime horizon and discounted outcomes at a 5% annual rate. The risks of myocardial infarction and death were
calculated using data from the diabetes subgroup, and the risks of bleeding were calculated using data from the overall group
from the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel
Thrombolysis in Myocardial Infarction 38 trial. Direct costs were estimated using official Brazilian open data. Quality of
life values were obtained through literature search. Univariate and multivariate sensitivity analyses were performed.
Results: Prasugrel was associated with more quality-adjusted life-years (QALYs) (5.03 vs 4.94) and higher costs (US$975.11 vs
US$575.97), resulting in an incremental cost-utility ratio (ICUR) of US$4303.86/QALY. In one-way sensitivity analysis, the
costs of prasugrel had the greatest impact on ICUR, followed by the initial age entering the cohort. In the probabilistic
sensitivity analysis, all ICUR values simulations were less than one Brazilian gross domestic product per capita/QALY (US
$5802.86).
Conclusions: Given the appealing economic profile, the clinical debate between reducing the risk of myocardial infarction and
increasing the risk of bleeding may overcome economic concerns in the Brazilian National Health System.
Description
Palavras-chave
acute coronary syndrome, cost-benefit analysis, economic, models, platelet aggregation inhibitors
Citação
Piccin Padilla M, Macedo LSDN, França ACW, Meirelles I, Magliano CADS, Santos MDS. Cost Utility of Prasugrel in Postangioplasty Diabetic Patients. Value Health Reg Issues. 2022 Jul;30:134-139. doi: 10.1016/j.vhri.2021.11.004.