Cost Utility of Prasugrel in Postangioplasty Diabetic Patients

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dc.contributor.authorPadilla, Matheus Piccin
dc.contributor.authorMacedo, Luana Schroeder Damico Nascimento
dc.contributor.authorFrança, Ana Cláudia Wekmuller
dc.contributor.authorMeirelles, Isandra
dc.contributor.authorMagliano, Carlos Alberto da Silva
dc.contributor.authorSantos, Marisa da Silva
dc.date.accessioned2024-10-07T16:39:15Z
dc.date.available2024-10-07T16:39:15Z
dc.date.issued2022
dc.description.abstractObjectives: 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.
dc.identifier.citationPiccin 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.
dc.identifier.otherDOI:10.1016/j.vhri.2021.11.004.
dc.identifier.urihttps://dspace.inc.saude.gov.br/handle/123456789/472
dc.language.isoen
dc.publisherValue in Health regional Issues
dc.subjectacute coronary syndromeen
dc.subjectcost-benefit analysisen
dc.subjecteconomicen
dc.subjectmodelsen
dc.subjectplatelet aggregation inhibitorsen
dc.titleCost Utility of Prasugrel in Postangioplasty Diabetic Patients
dc.typeArticle
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