Cost-Effectiveness of Ticagrelor versus Clopidogrel in Acute Coronary Syndrome in Iran

Background: Clopidogrel is a P2Y 12 platelet antagonist commonly used for patients with acute coronary syndrome (ACS). However, higher risk of vascular ischemic complications and hypo-responsiveness of some patients to its therapeutic effects limits its use. Ticagrelor, a newer option with a better efficacy and safety profile, was approved by US FDA in 2011 and it was launched in Iran 3 years ago, however it is not included in Iran reimbursement coverage lists yet. This study aimed to determine the cost- effectiveness of ticagrelor in comparison with clopidogrel in Iranian ACS patients. Methods A one-year decision tree model combined with a 20-year Markov transition model was used to stimulate long-term cost and effectiveness of both ticagrelor and clopidogrel in Iran based on an Iranian payer perspective. The clinical efficacy data were extracted from PLATO trial and other published studies. Costs were estimated based on local costs in public sectors. Deterministic and probabilistic sensitivity analysis were used to test robustness of base case results over uncertainties of model inputs. Results Compared with the clopidogrel, treatment of Iranian ACS patients with ticagrelor for 20 years resulted in an additional cost of 2.39 USD $ in hypothetical cohort of 1000 patient. On the other hand, ticagrelor led to 7.2 QALY gain per 1000 hypothetical patients. Accordingly, the estimated incremental cost effectiveness ratio (ICER) for this analysis was 332.032 USD $ per one QALY gained. Conclusion Ticagrelor was a cost-effective antiplatelet medicine compared with clopidogrel in Iranian patients with ACS. Trial Registration: Not applicable