Ticagrelor versus clopidogrel for recurrent myocardial infarction: An outcomes-based agreement.

Autor:	Peasah SK; Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, India., Huang Y; Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, India., Venditto J; AstraZeneca Pharmaceuticals, UK., Brekosky R; Pharmacy Services, UPMC Health Plan, India., Belletti D; AstraZeneca Pharmaceuticals, UK., Campbell V; Pharmacy Services, UPMC Health Plan, India., Manolis C; Pharmacy Services, UPMC Health Plan, India., Good CB; Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, India.
Jazyk:	angličtina
Zdroj:	Exploratory research in clinical and social pharmacy [Explor Res Clin Soc Pharm] 2023 Oct 13; Vol. 12, pp. 100347. Date of Electronic Publication: 2023 Oct 13 (Print Publication: 2023).
DOI:	10.1016/j.rcsop.2023.100347
Abstrakt:	Background: Outcomes-based agreements (OBA) are performance-based risk-sharing agreements between manufacturers and payers which provide the opportunity for collection and evaluation of real-world outcomes to supplement clinical trials. Objectives: To describe an OBA comparing ticagrelor to clopidogrel in patients admitted with acute coronary syndrome (ACS) and proportion of recurrent myocardial infarction (MI) in a real-world setting. Methods: Commercial (CM) and Medicare (MC) insurance patients of a large regional health plan, who presented with ACS and were prescribed either ticagrelor or clopidogrel were prospectively analyzed. The cohort consisted of adults (18-85 years) discharged between January 1, 2019, and December 31, 2020, who were adherent to the study medications, within the confines of the OBA. The primary outcome of interest was the proportion of recurrent MI hospitalizations within one year of discharge. Results: There were 500 patients who met inclusion criteria in the ticagrelor cohort and 648 in the clopidogrel cohort. The mean age of patients in the ticagrelor cohort was 61.5 ± 10.5 years old and 66.5 ± 10.2 years in the clopidogrel cohort. The proportion of patients with type 2 diabetes, hypertension, or a history of congestive heart failure at baseline in the ticagrelor cohort was 31%, 85%, 14% respectively, and 43%, 90%, and 32% respectively in the clopidogrel cohort. The overall proportion of hospitalization for recurrent MI was 1.00% in the ticagrelor and 3.13% in the clopidogrel cohorts. In the follow-up propensity-matched analysis, although recurrent MI hospitalization was higher in the clopidogrel cohort (1.69% vs 1.21%) it was not statistically significant ( p -value 0.5242). Conclusion: Patients presenting with ACS and treated with ticagrelor had a lower rate of hospitalization for recurrent MI compared to patients treated with clopidogrel cohort within the confines of an OBA in a real-world setting. Competing Interests: The authors are employees of either UPMC Health Plan or AstraZeneca. This project is a result of an outcomes-based agreement between the two organizations. The authors report of no conflict of interest beyond being employees. (© 2023 The Authors.)
Databáze:	MEDLINE
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