Ticagrelor is an oral, direct-acting, selective and reversibly binding P2Y₁₂ receptor antagonist that prevents adenosine diphosphate (ADP)-mediated P2Y₁₂-dependent platelet activation and aggregation. The proposed new indication is ticagrelor, combined with low-dose (75 mg to 150 mg) acetylsalicylic acid (ASA), for the secondary prevention of atherothrombotic events in adult patients with a history of myocardial infarction (MI) (occurred at least one year ago) and a high risk of developing an atherothrombotic event. The suggested dose is 60 mg twice daily, orally. Ticagrelor should be combined with ASA unless ASA is contraindicated. Treatment with ticagrelor should be continued in patients with a history of MI for as long as the patient remains at high risk of an atherothrombotic event for a duration up to three years. At a submitted price of $1.48 per 60 mg tablet, the daily cost of treatment is $2.96 per patient (or $1,080 annually).

The manufacturer submitted a cost-utility analysis to assess the cost-effectiveness of ticagrelor + ASA versus ASA alone in patients with a history of MI (MI occurred at least one year ago) and a high risk of developing an atherothrombotic event. The analysis was based on an individual patient simulation model estimating long-term health care costs and quality-adjusted life-years (QALYs) over a lifetime horizon (40 years), from the perspective of the Canadian public health care payer. The manufacturer reported that ticagrelor + ASA was associated with greater QALYs and higher costs than ASA alone, with an estimated incremental cost per QALY gained of $59,724.

Contents

• Abbreviations
• Executive Summary
  • Background
  • Summary of identified limitations and key results
  • Conclusions
• Information on the Pharmacoeconomic Submission
  • 1. Summary of the Manufacturer’s Pharmacoeconomic Submission
  • 2. Manufacturer’s Base Case
  • 3. Summary of Manufacturer’s Sensitivity Analyses
  • 4. Limitations of Manufacturer’s Submission
  • 5. CADTH Common Drug Review Reanalyses
  • 6. Issues for Consideration
  • 7. Patient Input
  • 8. Conclusions
• APPENDIX 1. Cost Comparison
• APPENDIX 2. Summary of Key Outcomes
• APPENDIX 3. Additional Information
• APPENDIX 4. Reviewer Worksheets
• References

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