Cost-Effectiveness Comparison between Ticagrelor and Clopidogrel in Acute Coronary Syndrome in Iran
-
Amir Hashemi-meshkini
,
Amirmohammad Tajik
,
Nayyereh Ayati
,
Shekoufeh Nikfar
,
Reza Koochak
,
Saeed Yaghoubifard
,
Azam Abbasi
,
Mehdi Varmaghani
Abstract
Background: The present study aimed to determine the cost-effectiveness of ticagrelor compared with clopidogrel in Iranian patients with acute coronary syndrome (ACS).
Methods: A 1-year decision tree model combined with a 20-year Markov transition model was used to simulate the long-term cost and effectiveness of both ticagrelor and clopidogrel in Iran based on an Iranian payer’s perspective. Clinical efficacy data were extracted from the PLATO trial and other published studies. Costs were estimated based on local prices in public sectors. Deterministic and probabilistic sensitivity analyses were used to test the robustness of base-case results over the uncertainties of model inputs. All calculations, analyses, and modeling were done in TreeAge 2011 and Microsoft Excel 2013.
Results: Compared with clopidogrel, the treatment of Iranian ACS patients with ticagrelor for 20 years resulted in an additional cost of US$ 2.39 in a hypothetical cohort of 1000 patients. However, ticagrelor led to 7.2 quality-adjusted life-years (QALYs) gained per 1000 hypothetical patients. Accordingly, the estimated incremental cost-effectiveness ratio for this analysis was US$ 332.032 per 1 QALY gained.
Conclusion: Ticagrelor was a cost-effective antiplatelet medicine compared with clopidogrel in Iranian patients with ACS. This could help Iran’s policymakers to allocate resources more efficiently to ACS.
1. Overbaugh KJ. Acute coronary syndrome. Am J Nurs 2009;109:42-52.
2. Vedanthan R, Seligman B, Fuster V. Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res 2014;114:1959-1975.
3. Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. Int J Cardiol 2013;168:934-945.
4. Hertz JT, Sakita FM, Limkakeng AT, Mmbaga BT, Appiah LT, Bartlett JA, Galson SW. The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study. Afr J Emerg Med 2019;9:180-184.
5. Kolansky DM. Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden. Am J Manag Care. 2009 Mar;15(2 Suppl):S36-41.
6. Clark MG, Beavers C, Osborne J. Managing the acute coronary syndrome patient: Evidence based recommendations for anti-platelet therapy. Heart Lung 2015;44:141-149.
7. Wojakowski W, Tendera M, Tubaro M, Gierlotka M, Bueno H, Hochadel M, et al. Are Elderly Patients with Acute Coronary Syndromes Undertreated? Data from Euro Heart Survey on ACS III Registry. The American Journal of Cardiology 2013;111:1B.
8. Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi M, Pourmoghaddas A, Kojuri J, Ghaffari S, Sanaati H, Alaeddini F, Pourmirza B, Mir E; IPACE2 Registry Investigators. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open 2015;5:e007786.
9. Sarrafzadegan N, Mohammmadifard N. Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med 2019;22:204-210.
10. Alipour V, Zandian H, Yazdi-Feyzabadi V, Avesta L, Moghadam TZ. Economic burden of cardiovascular diseases before and after Iran's health transformation plan: evidence from a referral hospital of Iran. Cost Eff Resour Alloc 2021;19:1.
11. Ghushchyan V, Nair KV, Page RL 2nd. Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both. Vasc Health Risk Manag 2014;11:25-34.
12. Poorhosseini HR, Hosseini SK, Davarpasand T, Lotfi Tokaldany M, Salarifar M, Kassaian SE, Alidoosti M, Nozari Y, Nematipour E, Haji Zeinali AM, Aghajani H, Amirzadegan AR. Effectiveness of Two-Year versus One-Year Use of Dual Antiplatelet Therapy in Reducing the Risk of Very Late Stent Thrombosis after Drug-Eluting Stent Implantation. J Tehran Heart Cent 2012;7:47-52.
13. Jiang M, You JH. Review of pharmacoeconomic evaluation of genotype-guided antiplatelet therapy. Expert Opin Pharmacother 2015;16:771-779.
14. Alexander JH, Lopes RD, James S, Kilaru R, He Y, Mohan P, ei al; APPRAISE-2 Investigators. Apixaban with antiplatelet therapy after acute coronary syndrome. N Engl J Med 2011;365:699-708.
15. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007;50:e1-e157.
16. Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324:71-86.
17. Musallam A, Orvin K, Perl L, Mosseri M, Arbel Y, Roguin A, Lev EI. Effect of Modifying Antiplatelet Treatment to Ticagrelor in High-Risk Coronary Patients With Low Response to Clopidogrel (MATTIS). Can J Cardiol 2016;32:1246.e13-1246.e19.
18. Varenhorst C, Alström U, Braun OÖ, Storey RF, Mahaffey KW, Bertilsson M, Cannon CP, Scirica BM, Himmelmann A, James SK, Wallentin L, Held C. Causes of mortality with ticagrelor compared with clopidogrel in acute coronary syndromes. Heart 2014;100:1762-1769.
19. Orban M, Riegger J, Joner M, Tada T, Okrojek R, Hausleiter J, Kastrati A, Massberg S, Sibbing D. Dual thienopyridine low-response to clopidogrel and prasugrel in a patient with STEMI, cardiogenic shock and early stent thrombosis is overcome by ticagrelor. Platelets 2012;23:395-398.
20. Thomas MR, Storey RF. Clinical significance of residual platelet reactivity in patients treated with platelet P2Y12 inhibitors. Vascul Pharmacol 2016;84:25-27.
21. Yingping X, Huiliang L. GW25-e5265 The Improvement of Ticagrelor for Clopidogrel Resistance on Patients with Acute Coronary Syndrome. J Am Coll Cardiol 2014;64 (16_Supplement):C137.
22. Serebruany VL. Ticagrelor FDA approval issues revisited. Cardiology 2012;122:144-147.
23. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019;140:e125-e151.
24. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42:1289-1367.
25. Zyryanov SK, Belousov DY, Afanasyeva EV, Dumchenko EV. Analiz «vliyaniya na byudzhet» primeneniya antitrombotsitarnoi terapii tikagrelorom i klopidogrelom u patsientov s ostrym koronarnym sindromom, perenesshikh operatsiyu koronarnogo shuntirovaniya [Budget impact analysis of antiplatelet therapy with ticagrelor and clopidogrel in patients with acute coronary syndrome after coronary artery bypass surgery]. Ter Arkh 2016;88:39-49.
26. Abdel-Qadir H, Roifman I, Wijeysundera HC. Cost-effectiveness of clopidogrel, prasugrel and ticagrelor for dual antiplatelet therapy after acute coronary syndrome: a decision-analytic model. CMAJ Open 2015;3:E438-446.
27. Gasche D, Ulle T, Meier B, Greiner RA. Cost-effectiveness of ticagrelor and generic clopidogrel in patients with acute coronary syndrome in Switzerland. Swiss Med Wkly 2013;143:w13851.
28. Meadows A, Kaambwa B, Novielli N, Huissoon A, Fry-Smith A, Meads C, Barton P, Dretzke J. A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis. Health Technol Assess 2013;17:vi, xi-xiv, 1-322.
29. Ahmadi A, Soori H, Sajjadi H, Nasri H, Mehrabi Y, Etemad K. Current status of the clinical epidemiology of myocardial infarction in men and women: a national cross-sectional study in iran. Int J Prev Med 2015;6:14.
30. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA; PLATO Investigators; Freij A, Thorsén M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361:1045-1057.
31. Pawęska J, Macioch T, Perkowski P, Budaj A, Niewada M. Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results. Kardiol Pol 2014;72:823-830.
32. Grima DT, Brown ST, Kamboj L, Bainey KR, Goeree R, Oh P, Ramanathan K, Goodman SG. Cost-effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes in Canada. Clinicoecon Outcomes Res 2014;6:49-62.
33. Theidel U, Asseburg C, Giannitsis E, Katus H. Cost-effectiveness of ticagrelor versus clopidogrel for the prevention of atherothrombotic events in adult patients with acute coronary syndrome in Germany. Clin Res Cardiol 2013;102:447-58.
34. Nikolic E, Janzon M, Hauch O, Wallentin L, Henriksson M; PLATO Health Economic Substudy Group. Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study. Eur Heart J 2013;34:220-228.
35. Yamwong S, Permsuwan U, Tinmanee S, Sritara P. Long-term cost effectiveness of ticagrelor in patients with acute coronary syndromes in Thailand. Health Econ Rev 2014;4:17.
36. Mehregan M, Khosravi A, Farhadian M, Mohammadi Y. The age and cause decomposition of inequality in life expectancy between Iranian provinces: application of Arriaga method. BMC Public Health 2022;22:772.
37. Fuller R, Chavez B. Ticagrelor (brilinta), an antiplatelet drug for acute coronary syndrome. P T 2012;37:562-568.
38. Cowper PA, Pan W, Anstrom KJ, Kaul P, Wallentin L, Davidson-Ray L, Nikolic E, Janzon M, Levin LÅ, Cannon CP, Harrington RA, Mark DB. Economic analysis of ticagrelor therapy from a U.S. perspective: results from the PLATO study. J Am Coll Cardiol 2015;65:465-476.
39. Chin CT, Mellstrom C, Chua TS, Matchar DB. Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective. Singapore Med J 2013;54:169-175.
40. De la Puente C, Vallejos C, Bustos L, Zaror C, Velasquez M, Lanas F. Latin American Clinical Epidemiology Network Series - Paper 8: Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile. J Clin Epidemiol 2017;86:117-124.
41. Molina-Cuadrado E, Mateo-Carrasco H, Nieto-Guindo P, Rodríguez-Gómez P. Coste-efectividad a largo plazo de ticagrelor frente a clopidogrel en síndrome coronario agudo en España Long-term cost-effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome in Spain. Farm Hosp 2014;38:266-275.
42. Gomez Y, Adams E, Hoogmartens J. Analysis of purity in 19 drug product tablets containing clopidogrel: 18 copies versus the original brand. J Pharm Biomed Anal 2004;34:341-348.
2. Vedanthan R, Seligman B, Fuster V. Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res 2014;114:1959-1975.
3. Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. Int J Cardiol 2013;168:934-945.
4. Hertz JT, Sakita FM, Limkakeng AT, Mmbaga BT, Appiah LT, Bartlett JA, Galson SW. The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study. Afr J Emerg Med 2019;9:180-184.
5. Kolansky DM. Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden. Am J Manag Care. 2009 Mar;15(2 Suppl):S36-41.
6. Clark MG, Beavers C, Osborne J. Managing the acute coronary syndrome patient: Evidence based recommendations for anti-platelet therapy. Heart Lung 2015;44:141-149.
7. Wojakowski W, Tendera M, Tubaro M, Gierlotka M, Bueno H, Hochadel M, et al. Are Elderly Patients with Acute Coronary Syndromes Undertreated? Data from Euro Heart Survey on ACS III Registry. The American Journal of Cardiology 2013;111:1B.
8. Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi M, Pourmoghaddas A, Kojuri J, Ghaffari S, Sanaati H, Alaeddini F, Pourmirza B, Mir E; IPACE2 Registry Investigators. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open 2015;5:e007786.
9. Sarrafzadegan N, Mohammmadifard N. Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med 2019;22:204-210.
10. Alipour V, Zandian H, Yazdi-Feyzabadi V, Avesta L, Moghadam TZ. Economic burden of cardiovascular diseases before and after Iran's health transformation plan: evidence from a referral hospital of Iran. Cost Eff Resour Alloc 2021;19:1.
11. Ghushchyan V, Nair KV, Page RL 2nd. Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both. Vasc Health Risk Manag 2014;11:25-34.
12. Poorhosseini HR, Hosseini SK, Davarpasand T, Lotfi Tokaldany M, Salarifar M, Kassaian SE, Alidoosti M, Nozari Y, Nematipour E, Haji Zeinali AM, Aghajani H, Amirzadegan AR. Effectiveness of Two-Year versus One-Year Use of Dual Antiplatelet Therapy in Reducing the Risk of Very Late Stent Thrombosis after Drug-Eluting Stent Implantation. J Tehran Heart Cent 2012;7:47-52.
13. Jiang M, You JH. Review of pharmacoeconomic evaluation of genotype-guided antiplatelet therapy. Expert Opin Pharmacother 2015;16:771-779.
14. Alexander JH, Lopes RD, James S, Kilaru R, He Y, Mohan P, ei al; APPRAISE-2 Investigators. Apixaban with antiplatelet therapy after acute coronary syndrome. N Engl J Med 2011;365:699-708.
15. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007;50:e1-e157.
16. Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324:71-86.
17. Musallam A, Orvin K, Perl L, Mosseri M, Arbel Y, Roguin A, Lev EI. Effect of Modifying Antiplatelet Treatment to Ticagrelor in High-Risk Coronary Patients With Low Response to Clopidogrel (MATTIS). Can J Cardiol 2016;32:1246.e13-1246.e19.
18. Varenhorst C, Alström U, Braun OÖ, Storey RF, Mahaffey KW, Bertilsson M, Cannon CP, Scirica BM, Himmelmann A, James SK, Wallentin L, Held C. Causes of mortality with ticagrelor compared with clopidogrel in acute coronary syndromes. Heart 2014;100:1762-1769.
19. Orban M, Riegger J, Joner M, Tada T, Okrojek R, Hausleiter J, Kastrati A, Massberg S, Sibbing D. Dual thienopyridine low-response to clopidogrel and prasugrel in a patient with STEMI, cardiogenic shock and early stent thrombosis is overcome by ticagrelor. Platelets 2012;23:395-398.
20. Thomas MR, Storey RF. Clinical significance of residual platelet reactivity in patients treated with platelet P2Y12 inhibitors. Vascul Pharmacol 2016;84:25-27.
21. Yingping X, Huiliang L. GW25-e5265 The Improvement of Ticagrelor for Clopidogrel Resistance on Patients with Acute Coronary Syndrome. J Am Coll Cardiol 2014;64 (16_Supplement):C137.
22. Serebruany VL. Ticagrelor FDA approval issues revisited. Cardiology 2012;122:144-147.
23. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019;140:e125-e151.
24. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42:1289-1367.
25. Zyryanov SK, Belousov DY, Afanasyeva EV, Dumchenko EV. Analiz «vliyaniya na byudzhet» primeneniya antitrombotsitarnoi terapii tikagrelorom i klopidogrelom u patsientov s ostrym koronarnym sindromom, perenesshikh operatsiyu koronarnogo shuntirovaniya [Budget impact analysis of antiplatelet therapy with ticagrelor and clopidogrel in patients with acute coronary syndrome after coronary artery bypass surgery]. Ter Arkh 2016;88:39-49.
26. Abdel-Qadir H, Roifman I, Wijeysundera HC. Cost-effectiveness of clopidogrel, prasugrel and ticagrelor for dual antiplatelet therapy after acute coronary syndrome: a decision-analytic model. CMAJ Open 2015;3:E438-446.
27. Gasche D, Ulle T, Meier B, Greiner RA. Cost-effectiveness of ticagrelor and generic clopidogrel in patients with acute coronary syndrome in Switzerland. Swiss Med Wkly 2013;143:w13851.
28. Meadows A, Kaambwa B, Novielli N, Huissoon A, Fry-Smith A, Meads C, Barton P, Dretzke J. A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis. Health Technol Assess 2013;17:vi, xi-xiv, 1-322.
29. Ahmadi A, Soori H, Sajjadi H, Nasri H, Mehrabi Y, Etemad K. Current status of the clinical epidemiology of myocardial infarction in men and women: a national cross-sectional study in iran. Int J Prev Med 2015;6:14.
30. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA; PLATO Investigators; Freij A, Thorsén M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361:1045-1057.
31. Pawęska J, Macioch T, Perkowski P, Budaj A, Niewada M. Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results. Kardiol Pol 2014;72:823-830.
32. Grima DT, Brown ST, Kamboj L, Bainey KR, Goeree R, Oh P, Ramanathan K, Goodman SG. Cost-effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes in Canada. Clinicoecon Outcomes Res 2014;6:49-62.
33. Theidel U, Asseburg C, Giannitsis E, Katus H. Cost-effectiveness of ticagrelor versus clopidogrel for the prevention of atherothrombotic events in adult patients with acute coronary syndrome in Germany. Clin Res Cardiol 2013;102:447-58.
34. Nikolic E, Janzon M, Hauch O, Wallentin L, Henriksson M; PLATO Health Economic Substudy Group. Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study. Eur Heart J 2013;34:220-228.
35. Yamwong S, Permsuwan U, Tinmanee S, Sritara P. Long-term cost effectiveness of ticagrelor in patients with acute coronary syndromes in Thailand. Health Econ Rev 2014;4:17.
36. Mehregan M, Khosravi A, Farhadian M, Mohammadi Y. The age and cause decomposition of inequality in life expectancy between Iranian provinces: application of Arriaga method. BMC Public Health 2022;22:772.
37. Fuller R, Chavez B. Ticagrelor (brilinta), an antiplatelet drug for acute coronary syndrome. P T 2012;37:562-568.
38. Cowper PA, Pan W, Anstrom KJ, Kaul P, Wallentin L, Davidson-Ray L, Nikolic E, Janzon M, Levin LÅ, Cannon CP, Harrington RA, Mark DB. Economic analysis of ticagrelor therapy from a U.S. perspective: results from the PLATO study. J Am Coll Cardiol 2015;65:465-476.
39. Chin CT, Mellstrom C, Chua TS, Matchar DB. Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: a Singapore healthcare perspective. Singapore Med J 2013;54:169-175.
40. De la Puente C, Vallejos C, Bustos L, Zaror C, Velasquez M, Lanas F. Latin American Clinical Epidemiology Network Series - Paper 8: Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile. J Clin Epidemiol 2017;86:117-124.
41. Molina-Cuadrado E, Mateo-Carrasco H, Nieto-Guindo P, Rodríguez-Gómez P. Coste-efectividad a largo plazo de ticagrelor frente a clopidogrel en síndrome coronario agudo en España Long-term cost-effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome in Spain. Farm Hosp 2014;38:266-275.
42. Gomez Y, Adams E, Hoogmartens J. Analysis of purity in 19 drug product tablets containing clopidogrel: 18 copies versus the original brand. J Pharm Biomed Anal 2004;34:341-348.
| Files | ||
| Issue | Vol 18 No 2 (2023): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v18i2.13318 | |
| Keywords | ||
| Acute coronary syndrome Ticagrelor Clopidogrel Cost-effectiveness analysis | ||
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How to Cite
1.
Hashemi-meshkini A, Tajik A, Ayati N, Nikfar S, Koochak R, Yaghoubifard S, Abbasi A, Varmaghani M. Cost-Effectiveness Comparison between Ticagrelor and Clopidogrel in Acute Coronary Syndrome in Iran. J Tehran Heart Cent. 2023;18(2):94-101.
