Abstract 16390: Cost-effectiveness of a CYP2C19 Genotype-guided Antiplatelet Strategy in ST-elevation Myocardial Infarction Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Danny M Claassens ◽  
Gerrit J Vos ◽  
Cornelis Boersma ◽  
Thomas Bergmeijer ◽  
Rik Hermanides ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Cost Savings ◽  
Exploratory Analysis ◽  
St Elevation Myocardial Infarction ◽  
Sensitivity Analyses ◽  
Loss Of Function ◽  
Thrombotic Risk ◽  
St Elevation ◽  
Popular Genetics

Introduction: The POPular Genetics trial demonstrated that a genotype-guided strategy to select antiplatelet therapy in patients with ST-elevation myocardial infarction (STEMI) compared to universal treatment with ticagrelor or prasugrel, resulted in a reduction in bleedings without an increase in the thrombotic risk. The objective of this analysis was to assess the cost-effectiveness of the genotype-guided strategy. Methods: In the POPular Genetics trial, STEMI patients who underwent primary percutaneous coronary intervention were randomized to an intervention or a control arm. In the intervention arm CYP2C19 genetic testing for the *2 and *3 loss-of-function alleles took place. Carriers of a loss-of-function allele were treated with ticagrelor or prasugrel, while noncarriers were treated with clopidogrel. In the control arm patients were treated with ticagrelor or prasugrel. An alongside clinical-trial cost-effectiveness analysis was conducted based on a decision-model with 1000 patients in both groups. A hybrid model, consisting of a 1-year decision tree combined with a 25-years Markov model was developed, to estimate the life-time cost-effectiveness from a societal perspective. Outcome measures were costs, quality-adjusted life-years (QALYs) and incremental cost per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to account for the uncertainty around the key parameters. In an exploratory analysis the price for ticagrelor and prasugrel was the same as clopidogrel, to simulate the effect of generic ticagrelor and prasugrel in the future. Results: The genotype-guided strategy resulted in 26.87 QALY gained with cost-savings of є601,807 indicating that the genotype-guided strategy is a cost-saving intervention. The exploratory analysis - keeping the price of antithrombotic therapies at the same price level - resulted in cost-savings of є137,980. Deterministic and probabilistic sensitivity analyses confirmed the robustness of the base-case analysis. Conclusion: Based on the POPular Genetics trial, a genotype-guided strategy compared to universal ticagrelor or prasugrel treatment resulted in favorable cost-effectiveness with QALYs gained and cost-savings.

Abstract 3774: Cost Effectiveness Of Enoxaparin In Patients With ST-elevation Myocardial Infarction: Results From EXTRACT-TIMI 25

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zefeng Zhang ◽  
Paul Kolm ◽  
Wei Zhang ◽  
Edward Ewen ◽  
Claudine Jurkovitz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Unfractionated Heparin ◽  
Cost Effective ◽  
St Elevation Myocardial Infarction ◽  
Published Data ◽  
Outpatient Procedures ◽  
Life Years ◽  
St Elevation ◽  
The Difference

Background: The efficacy of enoxaparin versus unfractionated heparin in the setting of ST-elevation myocardial infarction (STEMI) has been demonstrated in EXTRACT-TIMI 25, with 17% reductions in relative risk in the primary endpoint of death or nonfatal recurrent myocardial infarction (MI) (p<0.0001). This study considers the cost effectiveness of enoxaparin versus unfractionated heparin with fibrinolysis based on EXTRACT-TIMI 25. Methods: The ITT population of 20,479 patients from 48 countries were monitored for clinical and adverse events during the index hospitalization and through 30 days. Trial-wide resource utilization from all participating countries was used in the analysis while all costs were based on 2004 US costs. Medicare Fee Schedule was used for outpatient procedures and DRGs were applied for index and subsequent hospitalizations costs. Lost life years associated with 30-day in-trial events (death, MI and stroke) were estimated from published data from Framingham. Results: Overall, costs of index hospitalizations and outpatient procedures were lower, while costs for the subsequent hospitalization were higher for the enoxaparin patients. Total 30 days’ costs remained lower for enoxaparin, although the difference did not reach significance. Life years lost were significantly less with enoxaparin. For lifetime, when costs beyond the trial period were considered, the costs of enoxaparin in patients with STEMI were $506 higher, and the incremental cost-effectiveness ratio of enoxaparin compared to UFH was $4,369 per life year gained, with 99.9% of estimates falling below the $50,000 per life year gained threshold. Conclusions: Enoxaparin is effective in reducing mortality or nonfatal MI, and is highly cost-effective strategy in the US settings for the treatment of STEMI patients.

Cost-Effectiveness Analysis of Short-Term Clopidogrel Therapy for ST Elevation Myocardial Infarction

2010 ◽  
Vol 9 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Kyle B. Gibler ◽  
Haiden A. Huskamp ◽  
Marc S. Sabatine ◽  
Sabina A. Murphy ◽  
David J. Cohen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Cost Effectiveness Analysis ◽  
St Elevation Myocardial Infarction ◽  
Short Term ◽  
Effectiveness Analysis ◽  
Clopidogrel Therapy ◽  
St Elevation

scholarly journals Acute ST-elevation myocardial infarction due to in-stent thrombosis after administering tranexamic acid in a high cardiac risk patient

2019 ◽  
Vol 12 (4) ◽  
pp. e227957 ◽  
Author(s):  
Yvonne E Kaptein
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Tranexamic Acid ◽  
Stent Thrombosis ◽  
Cardiac Risk ◽  
St Elevation Myocardial Infarction ◽  
Thrombotic Risk ◽  
Stent Restenosis ◽  
St Elevation ◽  
Obtuse Marginal

Tranexamic acid (TXA) is an antifibrinolytic which minimises bleeding and transfusions, with thrombotic risk. Our patient had known coronary artery disease with post-TXA acute ST-elevation myocardial infarction (STEMI) due to in-stent thrombosis. He had five drug-eluting stents (DES): two overlapping DES in mid-LAD (3 years ago), and two overlapping DES in distal right coronary artery and one DES in obtuse-marginal (1.5 years ago). After TXA, both overlapping stent locations thrombosed. Of nine reports of post-TXA acute MI, only one had complex stent anatomy (bifurcation stent to left circumflex/first obtuse-marginal) with other single stents, and only the complex stent thrombosed. Post-TXA MI was more often STEMI caused by arterial thrombosis, rather than non-STEMI caused by blood loss, hypotension or demand ischaemia. Overlapping and bifurcation stents thrombosed; single stents remained patent. In conclusion, overlapping stents, bifurcation stents, excessive stent length and previous in-stent restenosis/thrombosis may increase thrombotic risk. TXA should be administered cautiously with complex stent anatomy.

scholarly journals Systematic investment in the delivery of guideline-coherent therapy reduces mortality and overall costs in patients with ST-elevation myocardial infarction: Results from the Stent for Life economic model for Romania, Portugal, Basque Country and Kemerovo region

2019 ◽  
Vol 9 (8) ◽  
pp. 902-910
Author(s):  
Bastian Wein ◽  
Anna Bashkireva ◽  
Alex Au-Yeung ◽  
Adam Yoculan ◽  
Dragos Vinereanu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Healthcare Costs ◽  
Basque Country ◽  
Cost Savings ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
St Elevation

Aims: The Stent for Life initiative aims at the reduction of mortality in patients with ST-elevation myocardial infarction by enhancing timely access to primary percutaneous coronary intervention. To assess the associated health and socioeconomic impact, the Stent for Life economic project was launched and applied to four model regions: Romania, Portugal, the Basque Country in Spain, and the Kemerovo region in the Russian Federation. Methods and results: The Stent for Life economic model is based on a decision tree that incorporates primary percutaneous coronary intervention rates and mortality. Healthcare costs and indirect costs caused by loss of productivity were estimated. A baseline scenario simulating the status quo was compared to the Stent for Life scenario which integrated changes initiated by the Stent for Life programme. In the four model regions, primary percutaneous coronary intervention numbers rose substantially between 29–303%, while ST-elevation myocardial infarction mortality was reduced between 3–10%. Healthcare costs increased by 8% to 70%. Indirect cost savings ranged from 2–7%. Net societal costs were reduced in all model regions by 2–4%. Conclusion: The joint effort of the Stent for Life initiative and their local partners successfully saves lives. Moreover, the increase in healthcare costs was outweighed by indirect cost savings, leading to a net cost reduction in all four model regions. These findings demonstrate that systematic investments to improve the access of ST-elevation myocardial infarction patients to guideline-coherent therapy is beneficial, not only for the individual, but also for the society at large.

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