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Ticagrelor use in acute myocardial infarction: Balancing evidence‐based medicine with affordability
Author(s) -
Walker Andrew L.,
Sorensen Teshia,
Gabriel Paolo P.,
Sledge Tyler,
Morshedzadeh Jack H.,
Owan Theophilus,
Shah Rashmee U.
Publication year - 2018
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1010
Subject(s) - ticagrelor , copayment , medicine , clopidogrel , interquartile range , myocardial infarction , acute coronary syndrome , emergency medicine , prasugrel , retrospective cohort study , health care , health insurance , economics , economic growth
Study objective Data from randomized controlled trials support a mortality benefit with ticagrelor vs clopidogrel among patients with acute myocardial infarction (AMI). Many health care providers preferentially treat patients with AMI with ticagrelor. The goal of this study was to determine the association between out‐of‐pocket drug costs and ticagrelor continuation compared with switching to clopidogrel among patients hospitalized for AMI, after a pharmacist‐led discussion on outpatient copayment costs for ticagrelor. Design Retrospective cohort study. Setting A tertiary care academic medical center. Patients Patients with AMI were hospitalized between February 15, 2015 and January 23, 2017, who were loaded with ticagrelor on presentation. Main results Of 143 patients with AMI loaded with ticagrelor, 70 (49%) were switched to clopidogrel after cost discussion. The median monthly ticagrelor copayment was $268.29 (interquartile range [IQR] $45‐$350) for switchers vs $18 (IQR $6‐$24) for nonswitchers ( P < .001). Patients with copayments of $100/month or more were 3.4 times more likely to switch to clopidogrel (relative risk 3.41, 95% confidence interval 2.12‐5.47), compared with patients with copayments of less than $100/month. Conclusions After a discussion of outpatient costs, half of patients with AMI were switched from ticagrelor to clopidogrel when given the choice.