Precision Health Economics, 133 Federal Street, 10th floor, Boston, MA, 02110, USA.
University of North Carolina at Charlotte, College of Health and Human Services, Charlotte, NC, USA.
Am J Cardiovasc Drugs. 2022 Jan;22(1):93-104. doi: 10.1007/s40256-021-00491-9. Epub 2021 Jul 31.
The objective of this study was to evaluate a US hospital's cost implications and outcomes of cangrelor use in percutaneous coronary intervention (PCI) patients with two or more angiographic high-risk features (HRFs), including avoidance of oral P2Y inhibitor pretreatment in patients requiring cardiac surgery. Intravenous cangrelor provides direct, immediate onset and rapid-offset P2Y inhibition, which may reduce the necessity for oral P2Y pretreatment.
A decision analytic model was developed, estimating the annual impact over 3 years of cangrelor availability. Ischemic and bleeding events (48 h) from randomized clinical trial data were extrapolated to 30 days. Event costs were from the CHAMPION PHOENIX Economics substudy. Rates of coronary artery disease (CAD) presentation, PCI, oral P2Y pretreatment, and inpatient hospitalization costs were from published literature and clinical experts. Scenario analyses evaluated the impact of cangrelor availability on potential reduced P2Y pretreatment rates by 50-100%. Drug costs were 2019 wholesale acquisition costs and, where necessary, all costs were adjusted to 2019 dollars.
In a hospital treating 1000 CAD PCI inpatients annually, increasing cangrelor use from 11 to 32% resulted in a reduction in 48-h ischemic events/year by 5.7%, while bleeding events increased by 2.9%. Total costs of $1,135,472 declined 12.8%, with a 50% reduction in P2Y pretreatment or 30% with no pretreatment. Savings were driven by a decrease in ischemic events, decrease in glycoprotein IIb/IIIa inhibitor use, and less need for and shorter oral P2Y inhibitor washout period for surgery patients.
Use of cangrelor in patients with two or more angiographic HRFs may improve outcomes and lower hospital budgets, mainly from avoiding surgery delays necessitated by oral P2Y inhibitor pretreatment.
本研究旨在评估美国某家医院使用坎格瑞洛对接受经皮冠状动脉介入治疗（PCI）且存在两种或以上血管造影高危特征（HRF）的患者的成本影响和结果，这些 HRF 包括避免需要心脏手术的患者进行口服 P2Y 抑制剂预处理。静脉内坎格瑞洛可提供直接、即刻起效和快速停药的 P2Y 抑制作用，这可能减少对口服 P2Y 预处理的需求。
建立了一个决策分析模型，以估算三年内坎格瑞洛供应的年度影响。从随机临床试验数据推断出缺血和出血事件（48 小时），并将其外推至 30 天。事件成本来自 CHAMPION PHOENIX 经济学子研究。冠心病（CAD）发作率、PCI、口服 P2Y 预处理和住院治疗费用来自已发表的文献和临床专家。情景分析评估了坎格瑞洛供应对潜在降低 50-100%的 P2Y 预处理率的影响。药物成本为 2019 年批发采购成本，在必要时，所有成本均调整为 2019 年的美元。
在一家每年治疗 1000 例 CAD PCI 住院患者的医院中，将坎格瑞洛的使用从 11%增加到 32%，可使每年的 48 小时缺血事件减少 5.7%，而出血事件增加 2.9%。总费用为 1135472 美元，下降了 12.8%，其中 P2Y 预处理减少 50%或不进行预处理减少 30%。节省主要来自缺血事件减少、糖蛋白 IIb/IIIa 抑制剂使用减少，以及手术患者对口服 P2Y 抑制剂冲洗期的需求减少和时间缩短。
在存在两种或以上血管造影 HRF 的患者中使用坎格瑞洛可能改善预后并降低医院预算，主要是通过避免因口服 P2Y 抑制剂预处理而导致的手术延迟。
