PARIS, October 26 /PRNewswire/ --
Results from three separate European health economic analyses of the TRITON-TIMI 38 study showed that treatment with Efient(R) (prasugrel) compared with clopidogrel (Plavix(R)) reduced medical costs by lowering rehospitalisation rates and the need for repeat percutaneous coronary interventions (PCI), including stenting. The analyses, conducted in Germany, France and the UK, showed prasugrel to be a cost-effective treatment option for patients with acute coronary syndrome (ACS) undergoing PCI. These data were presented today at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 12th Annual European Congress in Paris.
The analyses showed that treatment with prasugrel compared with branded clopidogrel lowered medical costs due to the demonstrated reduction in the risk of thrombotic cardiovascular events following an initial PCI, including events during the initial hospitalisation as well as recurrent heart attacks, rehospitalisations and repeat stenting procedures, across several patient groups studied. The greater efficacy of prasugrel in TRITON-TIMI 38 resulted in reductions in the use of expensive healthcare resources such as intensive care unit expenses, rehospitalisations and stenting procedure costs.(1, 2, 3)
"These health economic analyses are important because the results provide the healthcare community with new data to help evaluate prasugrel as an appropriate and cost-effective antiplatelet therapy for patients with acute coronary syndrome undergoing angioplasty," said Joerg Rustige, M.D., Medical Director Cardiovascular, Europe, Eli Lilly and Company. "We believe there is a need to provide innovative medications that improve patient outcomes and do not contribute to increased healthcare costs for patients and the healthcare system."
"ACS is a life-threatening condition that is associated with a significant emotional and economic burden to patients," said Thomas Portz, Ph.D., Head of Public Affairs, Daiichi Sankyo Europe, GmbH. "It is essential that effective new antiplatelet therapies with minimal drug budget impact to the healthcare system are available for ACS-PCI patients."
German Analysis
An analysis of the TRITON-TIMI 38 health economic sub-study performed using German healthcare costs showed medical expenses over the 14.5-month trial period were lower with prasugrel compared with branded clopidogrel by euro 20 per patient in the population of patients who had no history of transient ischemic attack/stroke, weight>=60kg and were <75 years-old due to fewer rehospitalisations for PCI. At the end of the 14.5-month follow-up period, treatment with prasugrel was estimated to reduce costs associated with rehospitalisations for heart attack, stroke or revascularisation by euro 140 per patient, while increasing bleeding-related costs by euro 25 per patient.
Analyses of key sub-populations revealed that prasugrel was an economically dominant strategy compared with generic clopidogrel for patients with diabetes, STEMI and NSTEMI ACS and an index procedure involving PCI with a bare metal stent. "Dominant" is a health economics term used when clinical data in a standard cost-effectiveness analysis showed that a drug both reduced overall costs and provided better efficacy.
Results of the German analysis also showed that prasugrel was a cost-effective treatment option both early and late compared with generic clopidogrel at a cost of euro 1.80 per day across patient sub-populations. Treatment with prasugrel yielded an incremental net cost with prasugrel of euro 285 per patient over the 14.5 months of the study. The results also showed an incremental cost-effectiveness ratio (ICER) of euro 2,213 per life-year gained.
This sub-analysis of TRITON-TIMI 38 included 6,705 patients from eight countries, including Australia, Canada, France, Germany, Italy, Spain, the UK and the United States. Medical costs, including drug expenses, were estimated based on the German healthcare system. Costs for study drugs were estimated using public price per tablet (prasugrel = euro 2.94 per day; clopidogrel = euro 2.68 per day). The cost-effectiveness analysis compared prasugrel against both branded and generic clopidogrel. Life expectancy was estimated based on in-trial cardiovascular and bleeding events, using statistical models developed from a similar population from the Saskatchewan Health Database. Costs incurred in additional years of life were not included in the base case. Elizabeth M. Mahoney, Sc.D., Director, Health Economics and Technology Assessment, St. Luke's Mid America Heart Institute, Kansas City, MO, and colleagues, performed the analysis.
French Analysis
A separate total budget impact analysis done in France showed that compared with branded clopidogrel, prasugrel reduced total medical costs including medical and pharmacy costs, over approximately one year, in part by reducing recurrent hospital stays for repeat angioplasty procedures such as stenting. These results showed potential savings of euro 176 per patient over the 380-day trial period, or euro 0.46 daily per patient, in the population of patients who had no history of transient ischemic attack/stroke, weight>=60kg and were <75 years-old due to fewer rehospitalisations for PCI.
Over a one-year time horizon, in the recommended 10 mg dose group, the total budget impact for all patients for recurrent hospital stays was euro 4,354,983.17 for prasugrel and euro 4,827,315.74 for clopidogrel, a savings of euro 472,332.57. Results of this budget impact model showed that the prevention of recurrent events requiring rehospitalisation with prasugrel generated savings that could offset price differences with clopidogrel.
The French sub-analysis was based on index and recurrent hospital stays related to cardiovascular and bleeding causes from a health economic sub-analysis of 6,705 patients from eight countries, including Australia, Canada, France, Germany, Italy, Spain, the UK and the US, from the TRITON-TIMI 38 study with a mean 380 days of follow-up. A specific diagnosis-related group (DRG) was identified for each hospital stay based on French data. Karine Chevreul, M.D., Henri Mondor Hospital, URC Health Economics, Creteil, Paris, and colleagues performed this analysis.
UK Analysis
A third UK-based health economic analysis based on TRITON-TIMI 38 data showed that compared with branded clopidogrel, prasugrel was a cost-effective treatment option in ACS-PCI patients across patient sub-populations. Results of the analysis showed that over a lifetime horizon, treatment with prasugrel was associated with life expectancy gains of 0.06 years and 0.05 additional quality-adjusted life-year (QALY), due primarily to a reduced rate of MI, and incremental costs of 169 pounds Sterling per patient. A statistical analysis showed a 72 percent chance of prasugrel being cost-effective compared with branded clopidogrel at a willingness-to-pay of 20,000 pounds per QALY. A QALY takes into account both the quantity and quality of life generated by healthcare interventions.
(CONTINUA)
