scholarly journals Aspirin with Low-Dose Ticagrelor or with Low-Dose Rivaroxaban for Secondary Prevention: A Cost Per Outcome Analysis

2022 ◽  
Author(s):  
Gal Tsaban ◽  
Hilmi Alnsasra ◽  
Aref El Nasasra ◽  
Amjad Abu-Salman ◽  
Ala Abu-Dogosh ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Annual Cost ◽  
Cardiovascular Events ◽  
Low Dose ◽  
Outcome Data ◽  
Major Adverse Cardiovascular Events ◽  
Outcome Analysis ◽  
Number Needed To Treat ◽  
Value For Money ◽  
Value Analysis

Abstract Introduction: Secondary prevention of cardiovascular events among patients with diagnosed cardiovascular disease and high ischemic risk poses a significant challenge in clinical practice. The combinations of aspirin with low dose (LD) Ticagrelor or LD-Rivaroxaban have shown superiority in preventing major adverse cardiovascular events (MACE) than aspirin treatment alone. The comparative value for money of these two regimens remains unexplored.Methods: We analyzed each regimen's annual cost needed to treat (CNT) by multiplying the annualized number needed to treat (aNNT) by the annual cost of each drug. The aNNTs were based on outcome data from PEGASUS TIMI-54 and COMPASS trials. Scenario analyses were performed to overcome variances in terms of population risk. Costs were based on 2021 US prices. The primary outcome was defined as CNT to prevent one MACE across the two regimens. Secondary value analysis was performed for myocardial infarction (MI), stroke, and CV death as separate outcomes. Results: The aNNTs to prevent MACE with LD-Ticagrelor and with LD-Rivaroxaban were 229 [95% confidence interval (CI):141-734] and 147 (95%CI:104-252), respectively. At an annual cost of 3,618$ versus 4,308$, the corresponding CNTs were 828,478$ (95%CI:510,111$-2,655,471$) with LD-Ticagrelor and 633,270$ (95%CI:448,028$-1,085,607$) with LD-Rivaroxaban. LD-Rivaroxaban.Conclusion: Combining aspirin with LD-Rivaroxaban provides better value for money than with LD-Ticagrelor for secondary prevention of MACE.

Abstract 13807: Semaglutide Provides More Value for Money Than Dulaglutide or Liraglutide for Prevention of Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Established Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Joseph Azuri ◽  
Enis Aboalhasan ◽  
Ariel Hammerman ◽  
Ronen Arbel
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Sensitivity Analysis ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Number Needed To Treat ◽  
Value For Money ◽  
The Cost

Introduction: The Glucagon-Like Peptide-1 receptor agonists (GLP-1a) semaglutide, dulaglutide, and liraglutide reduce major adverse cardiovascular events (MACE) in patients with Type 2 diabetes mellitus ( T2DM) and established CVD. The American Diabetes Association currently recommends providing GLP-1a therapy to this patient population independently of glycaemic control. Despite proven clinical benefits, providing GLP-1a to all guideline eligible patients is a significant cost burden on healthcare systems. Therefore, it is imperative to compare the value for money of these agents. Hypothesis: The newly introduced GLP-1a Semaglutide may be cost-saving compared to dulaglutide and liraglutide for preventing MACE in patients with established CVD and T2DM. Methods: We calculated the cost needed to prevent one MACE, by multiplying the annualized number needed to treat to prevent one event, by the annual cost of the therapy. Efficacy estimates were extracted from published RCT data. We performed a sensitivity analysis to mitigate differences between trial populations and other uncertainties. Drug costs were based on published US prices. Results: The cost needed to prevent one MACE with semaglutide is $557,187 ($331,491-$2,194,483) compared to $1,179,360 ($732,888-$2,746,224) with liraglutide and $1,605,904 ($706,044-∞) for dulaglutide. Sensitivity analysis confirmed the advantage of semaglutide. Conclusions: Semaglutide prescribed for secondary prevention of MACE in patients with T2DM and established CVD seems to provide more value for money than dulaglutide and liraglutide for the same purpose.

Abstract 14730: Oral Semaglutide Provides Less Value for Money Than Subcutaneous Semaglutide for the Prevention of Major Adverse Cardiovascular Events, but Significantly More Value for Money for the Prevention of Cardiovascular Mortality

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ronen Arbel ◽  
Enis Aboalhasan ◽  
Ariel Hammerman ◽  
Joseph Azuri
Keyword(s):  
Sensitivity Analysis ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Economic Value ◽  
Drug Acquisition ◽  
Drug Acquisition Cost ◽  
Secondary Outcome ◽  
Major Adverse Cardiovascular Events ◽  
Number Needed To Treat ◽  
Value For Money

Introduction: Semaglutide, a subcutaneous Glucagon-Like Peptide-1 receptor agonist, reduces the risk of major adverse cardiovascular events (MACE) in patients with Type 2 diabetes mellitus (T2DM). An oral version of semaglutide is now available, and patients may prefer it over a subcutaneous injection. The value for money of the oral version for the prevention of MACE is not clear. Hypothesis: Oral semaglutide provides less value for money than subcutaneous semaglutide for the prevention of MACE, but more value for money for the prevention of the single endpoint of cardiovascular mortality (CVM). Methods: We calculated the cost needed to prevent (CNT) one MACE, by multiplying the one-year number needed to treat to prevent one event, by the annual cost of the therapy. Efficacy estimates were extracted from published RCT data. The CNT to prevent one event of the single endpoint of CVM was analyzed as a secondary outcome. We performed a sensitivity analysis to mitigate primary differences between the RCTs. Drug costs were calculated as 75% of the US National Average Drug Acquisition Cost listing in June 2020. Results: The CNT to prevent one MACE with subcutaneous semaglutide in SUSTAIN-6 is $641,823 ($402,021-$3,533,533) compared to $855,040 (95% CI: $420,840-∞) with oral semaglutide in PIONEER 6. The lower cost of subcutaneous semaglutide was confirmed in a sensitivity analysis simulating the effects of the drugs in both RCTs. The CNT to prevent one CVM with semaglutide is $16,342,560 ($2,020,704.00-∞) compared to $1,315,720 (95% CI: $921,004-$8,392,414) with oral semaglutide. Conclusions: Subcutaneous semaglutide prescribed for the prevention of MACE in patients with T2DM is moderately cost-saving compared to oral semaglutide for the same purpose. However, for the prevention of CVM, the oral version provides significantly better economic value.

scholarly journals Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034564
Author(s):  
Ralph K Akyea ◽  
Jo Leonardi-Bee ◽  
Folkert W Asselbergs ◽  
Riyaz S Patel ◽  
Paul Durrington ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiovascular Events ◽  
Prediction Models ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Prognostic Models ◽  
Major Adverse Cardiovascular Events ◽  
Bibliographic Databases ◽  
Analysis Model

IntroductionCardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. With advances in early diagnosis and treatment of CVD and increasing life expectancy, more people are surviving initial CVD events. However, models for stratifying disease severity risk in patients with established CVD for effective secondary prevention strategies are inadequate. Multivariable prognostic models to stratify CVD risk may allow personalised treatment interventions. This review aims to systematically review the existing multivariable prognostic models for the recurrence of CVD or major adverse cardiovascular events in adults with established CVD diagnosis.Methods and analysisBibliographic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science) will be searched, from database inception to April 2020, using terms relating to the clinical area and prognosis. A hand search of the reference lists of included studies will also be done to identify additional published studies. No restrictions on language of publications will be applied. Eligible studies present multivariable models (derived or validated) of adults (aged 16 years and over) with an established diagnosis of CVD, reporting at least one of the components of the primary outcome of major adverse cardiovascular events (defined as either coronary heart disease, stroke, peripheral artery disease, heart failure or CVD-related mortality). Reviewing will be done by two reviewers independently using the pre-defined criteria. Data will be extracted for included full-text articles. Risk of bias will be assessed using the Prediction model study Risk Of Bias ASsessment Tool (PROBAST). Prognostic models will be summarised narratively. If a model is tested in multiple validation studies, the predictive performance will be summarised using a random-effects meta-analysis model to account for any between-study heterogeneity.Ethics and disseminationEthics approval is not required. The results of this study will be submitted to relevant conferences for presentation and a peer-reviewed journal for publication.PROSPERO registration numberCRD42019149111.

Rationale for a Trial of Low-Dose Aspirin for the Primary Prevention of Major Adverse Cardiovascular Events and Vascular Dementia in the Elderly

Drugs & Aging ◽  
2003 ◽  
Vol 20 (12) ◽  
pp. 897-903 ◽  
Author(s):  
Mark R Nelson ◽  
Christopher M Reid ◽  
Lawrence J Beilin ◽  
Geoffrey A Donnan ◽  
Colin I Johnston ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Vascular Dementia ◽  
Cardiovascular Events ◽  
Low Dose ◽  
The Elderly ◽  
Major Adverse Cardiovascular Events ◽  
Dose Aspirin ◽  
Low Dose Aspirin
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