Cost-Consequence Analysis of Using Cangrelor in High Angiographic Risk Percutaneous Coronary Intervention Patients: A US Hospital Perspective

• Published in: American journal of cardiovascular drugs : drugs, devices, and other interventions Vol. 22; no. 1; pp. 93 - 104
• Main Authors: Jensen, Ivar S., Wu, Elizabeth, Cyr, Philip L., Claussen, Marc, Winkler, Thomas, Salahuddin, Khalid, Prats, Jayne, Mahaffey, Kenneth W., Gibson, Charles Michael, Steg, Philippe Gabriel, Stone, Gregg W., Bhatt, Deepak L.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-01-2022; Springer Nature B.V
• Subjects: Acute coronary syndromes; Adenosine Monophosphate - analogs & derivatives; Adenosine Monophosphate - economics; Adenosine Monophosphate - therapeutic use; Angina pectoris; Angioplasty; Anticoagulants; Blood platelets; Cardiology; Cardiovascular disease; Coronary Angiography; Coronary vessels; Cost control; Costs and Cost Analysis; Glycoproteins; Heart attacks; Hospitals; Humans; Medicine; Medicine & Public Health; Original; Original Research Article; Patients; Percutaneous Coronary Intervention - adverse effects; Pharmacology/Toxicology; Pharmacotherapy; Purinergic P2Y Receptor Antagonists - economics; Purinergic P2Y Receptor Antagonists - therapeutic use; Risk Assessment; Surgery; Treatment Outcome; United States; Vein & artery diseases; United States; United States > US
• ISSN: 1175-3277; 1179-187X
• DOI: 10.1007/s40256-021-00491-9

Objectives
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
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inhibitor pretreatment in patients requiring cardiac surgery. Intravenous cangrelor provides direct, immediate onset and rapid-offset P2Y
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inhibition, which may reduce the necessity for oral P2Y
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pretreatment.
Methods
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
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pretreatment, and inpatient hospitalization costs were from published literature and clinical experts. Scenario analyses evaluated the impact of cangrelor availability on potential reduced P2Y
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pretreatment rates by 50–100%. Drug costs were 2019 wholesale acquisition costs and, where necessary, all costs were adjusted to 2019 dollars.
Results
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
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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
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inhibitor washout period for surgery patients.
Conclusion
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
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inhibitor pretreatment.