Background
Dual antiplatelet therapy (DAPT) is guideline therapy following acute coronary syndrome
(ACS). Novel, potent P2Y12 inhibitors have been developed and studied but it is unclear how this evidence has
been incorporated into patient care. We sought to describe the prescribing trends
and health care costs of P2Y12therapy in Australia over the last decade.
Method
The latest statistical data collected by the Pharmaceutical Benefit Scheme (PBS),
Australia, was reviewed. PBS codes for coronary indications were selected. Yearly
total prescriptions and cost were then compared between all three P2Y12 inhibitors. Linear trend modelling was used to observe general trends over the data
collection period.
Results
Total yearly P2Y12 scripts have more than doubled between 2010 (403,880 scripts) and 2020 (994,826 scripts).
Clopidogrel is the most prescribed P2Y12 inhibitor and has been for the last decade. Ticagrelor represents 26.2% of total
prescriptions but accounts for 75% of PBS spending. More than $30 million is spent
on ticagrelor every year with a cost per MACE prevented of $72,637. Prasugrel was
the least prescribed agent but was 41% cheaper per major adverse cardiac event (MACE)
prevented than ticagrelor before being removed from the Australian market. Without
prasugrel available, clopidogrel scripts have increased 10% and ticagrelor scripts
remain stable.
Conclusion
Clopidogrel remains the most prescribed P2Y12 agent in Australia, despite emergence of more potent P2Y12 inhibitors. Ticagrelor is increasingly prescribed but represents a disproportionately
large burden of spending. Whilst prasugrel is the most efficacious, cheaper than ticagrelor
and guideline recommended P2Y12 inhibitor after ACS, it represented the minority of scripts before being withdrawn.
Rather than use of a potent P2Y12 agent, clinicians are reverting to prescribing clopidogrel.
Keywords
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Article info
Publication history
Published online: August 01, 2022
Accepted:
June 6,
2022
Received in revised form:
May 2,
2022
Received:
November 16,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
