Cost-Effectiveness of Antithrombotic Agents for STEMI

Abstract

In Indonesia, the prevalence of Acute Coronary Syndrome (ACS) continues to rise annually and remains high. Aspirin and adenosine diphosphate receptor inhibitors are recommended as part of the dual antiplatelet therapy that is recommended by the standard guidelines for managing ACS. Ticagrelor, a new treatment option for ACS, has been made available during the current period of Indonesia's National Health Insurance. Ticagrelor is more effective, but it costs more. Objective: In patients with ST-Elevation Myocardial Infarction (STEMI), the goal of this study was to compare how much ticagrelor and clopidogrel cost when compared to one another with relative ratio (RR) analysis and 95% confidence interval (CI) with p<0.05 considered significant. This study was a decision tree-based retrospective cohort study with a one-year follow-up following the STEMI event. In 2017-2018, 496 patients, 92 of whom had taken ticagrelor and 404 of whom had taken clopidogrel, participated in the study at Dr. Sardjito General Hospital Yogyakarta. An incremental cost-effectiveness ratio (ICER) was used to present a cost-effectiveness analysis. In comparison to clopidogrel, the ticagrelor group's annual average total cost is higher. In the ticagrelor group, cardiovascular disease (CVD) event rates were 7.6%, while in the clopidogrel group, they were 21% (RR: 0.362, CI 95%: 0.173–0.755, p=0.005. Ticagrelor's ICER was IDR885.584 per CVD prevented compared to clopidogrel's. The yield of ticagrelor was lower (ICER <3 Gross Domestic Product/GDP) when compared to the WHO threshold ratio of willingness to pay (GDP per capita Indonesian = USD3.927, based on 2018). Ticagrelor is an antithrombotic that prevents CVD events in STEMI patients at the lowest cost.