Cost analysis of dual antiplatelet therapy with prasugrel and ticagrelor in patients with acute coronary syndrome after percutaneous coronary intervention

Aim. To conduct a cost analysis of using novel inhibitors of P2Y 12 (prasugrel and ticagrelor) in patients with acute coronary syndrome (ACS) in the Russian healthcare system.Material and methods. The analysis was performed using the design of a comparative study of prasugrel and ticagrelor ISAR-REACT 5. The loading and maintenance doses of the drugs, the percentage of patients who stopped therapy and the median duration of administration before withdrawal were taken into account. The cost of treating clinical events associated with the primary and secondary endpoints was estimated according to the data on diagnosis-related groups for 2020. The cost of hospitalization was calculated as the average of the cost of treating various diseases, taking into account the base rate for a hospital. The result was expressed as the weighted average cost per patient for 1 year (365 days). The maintenance dose used in calculations was 10 mg/day for prasugrel and 90 mg 2 times/day for ticagrelor.Results. Prasugrel is less expensive for use than ticagrelor. For 1-year therapy, the difference is 8386,31 rubles or 10,57%. The proportion of using prasugrel in 2019 was only 2,17%. With the current ratio of using ticagrelor and prasugrel, the budgetary pressures of therapy corresponding to 19,382.7 patient-years will amount to 1,534 billion rubles. An increase in the proportion of prasugrel leads to a decrease in the total expenses of managing patients with ACS after percutaneous coronary intervention who require antiplatelet therapy. With the complete replacement of ticagrelor with prasugrel, the savings will be 10,36% or 159,03 million rubles. With an increase in the proportion of prasugrel, the total expenses will decrease, and with a complete replacement of ticagrelor with prasugrel, the savings compared to using only ticagrelor will amount to 1,353.7 million rubles.Conclusion. The analysis showed that the use of prasugrel in the population is less costly in the healthcare system. However, the result obtained is relevant only with price changes for one of the drugs not exceeding 10% and not relevant with multidirectional simultaneous changes in prices for compared drugs. Increasing the proportion of prasugrel and replacing it with ticagrelor will reduce the budgetary pressures.