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 P2Y₁₂ inhibitor pretreatment in patients requiring cardiac surgery. Intravenous cangrelor provides direct, immediate onset and rapid-offset P2Y₁₂ inhibition, which may reduce the necessity for oral P2Y₁₂ 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 P2Y₁₂ pretreatment, and inpatient hospitalization costs were from published literature and clinical experts. Scenario analyses evaluated the impact of cangrelor availability on potential reduced P2Y₁₂ 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 P2Y₁₂ 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 P2Y₁₂ 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 P2Y₁₂ inhibitor pretreatment.

中文翻译：

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在高血管造影风险经皮冠状动脉介入治疗患者中使用坎格雷洛的成本后果分析：美国医院的观点

目标

本研究的目的是评估一家美国医院在具有两个或多个血管造影高危特征 (HRF) 的经皮冠状动脉介入治疗 (PCI) 患者中使用坎格雷洛的成本影响和结果，包括避免对需要进行口服 P2Y ₁₂抑制剂预处理的患者进行治疗。心脏手术。静脉注射坎格雷洛提供直接、即时和快速起效的 P2Y ₁₂抑制作用，这可能会减少口服 P2Y ₁₂预处理的必要性。

方法

开发了一个决策分析模型，估计了 3 年坎格雷洛可用性的年度影响。来自随机临床试验数据的缺血和出血事件（48 小时）被外推至 30 天。事件成本来自 CHAMPION PHOENIX Economics 子研究。冠状动脉疾病 (CAD) 表现、PCI、口服 P2Y ₁₂预处理和住院住院费用的发生率来自已发表的文献和临床专家。情景分析评估了坎格雷洛的可用性对 P2Y ₁₂预处理率降低 50-100% 的潜在影响。药品成本为 2019 年批发采购成本，如有必要，所有成本均调整为 2019 年美元。

结果

在一家每年治疗 1000 名 CAD PCI 住院患者的医院中，将坎格雷洛的使用量从 11% 增加到 32% 导致每年 48 小时缺血事件减少 5.7%，而出血事件增加 2.9%。1,135,472 美元的总成本下降了 12.8%，其中 P2Y ₁₂预处理减少了 50%，或者没有预处理减少了30%。节省的原因是缺血事件的减少、糖蛋白 IIb/IIIa 抑制剂的使用减少以及手术患者对口服 P2Y ₁₂抑制剂清除期的需求减少和缩短。

结论

在有两个或更多血管造影 HRF 的患者中使用坎格雷洛可能会改善结果并降低医院预算，主要是因为避免口服 P2Y ₁₂抑制剂预处理导致的手术延误。