Abstract 18228: Cost-Effectiveness of New Oral Antiplatelet Agents and Testing Strategies During Early Invasive Management of Acute Coronary Syndrome Patients

BACKGROUND: Prasugrel has become available with variable adoption across practices. Incremental cost-effectiveness analysis of prasugrel and other future agents relative to clopidogrel may provide rationale guidance for their appropriate use. METHODS: A Markov-model with baseline acute coronary syndrome (ACS) health state and subsequent death, nonfatal myocardial infarction, stent thrombosis, urgent revascularization, major bleeding, and malignancy was constructed with 15 one month cycles. Published incremental costs, utilities, and event frequency distributions from randomized trials and series were used to assign transition probabilities and “payoffs” as a function of time. A second model examined modification of therapy at critical time-points based on genetic and platelet function testing assays. Probabilistic 95% confidence intervals were calculated using the parameter distributions in the model. RESULTS: In ACS patients undergoing an early invasive strategy, prasugrel was dominant over clopidogrel w...