PMID- 37204675
OWN - NLM
STAT- MEDLINE
DCOM- 20230710
LR  - 20230718
IS  - 1179-187X (Electronic)
IS  - 1175-3277 (Print)
IS  - 1175-3277 (Linking)
VI  - 23
IP  - 4
DP  - 2023 Jul
TI  - Cost-Effectiveness and Budget Impact of a Novel Antithrombotic Drug Removal 
      System to Reduce Bleeding Risk in Patients on Preoperative Ticagrelor Undergoing 
      Cardiac Surgery.
PG  - 429-440
LID - 10.1007/s40256-023-00587-4 [doi]
AB  - BACKGROUND: Antithrombotic drugs, including the P2Y(12) inhibitor ticagrelor, 
      increase the risk of perioperative bleeding in patients requiring urgent cardiac 
      surgery. Perioperative bleeding can lead to increased mortality and prolong 
      intensive care unit and hospital stays. A novel sorbent-filled hemoperfusion 
      cartridge that intraoperatively removes ticagrelor via hemoadsorption can reduce 
      the risk of perioperative bleeding. We estimated the cost-effectiveness and 
      budget impact of using this device versus standard practices to reduce the risk 
      of perioperative bleeding during and after coronary artery bypass grafting from 
      the US healthcare sector perspective. METHODS: We used a Markov model to analyze 
      the cost-effectiveness and budget impact of the hemoadsorption device in three 
      cohorts: (1) surgery within 1 day from last ticagrelor dose; (2) surgery between 
      1 and 2 days from last ticagrelor dose; and (3) a combined cohort. The model 
      analyzed costs and quality-adjusted life years (QALYs). Results were interpreted 
      as both incremental cost-effectiveness ratios and net monetary benefits (NMBs) at 
      a cost-effectiveness threshold of $100,000/QALY. We analyzed parameter 
      uncertainty using deterministic and probabilistic sensitivity analyses. RESULTS: 
      The hemoadsorption device was dominant for each cohort. Patients with less than 1 
      day of washout in the device arm gained 0.017 QALYs at a savings of $1748 (USD), 
      for an NMB of $3434. In patients with 1-2 days of washout, the device arm yielded 
      0.014 QALYs and a cost savings of $151, for an NMB of $1575. In the combined 
      cohort, device gained 0.016 QALYs and a savings of $950 for an NMB of $2505. 
      Per-member-per-month cost savings associated with device was estimated to be 
      $0.02 for a one-million-member health plan. CONCLUSION: This model found the 
      hemoadsorption device to provide better clinical and economic outcomes compared 
      with the standard of care in patients who required surgery within 2 days of 
      ticagrelor discontinuation. Given the increasing use of ticagrelor in patients 
      with acute coronary syndrome, incorporating this novel device may represent an 
      important part of any bundle to save costs and reduce harm.
CI  - (c) 2023. The Author(s).
FAU - Cohen, Benjamin G
AU  - Cohen BG
AD  - Stage Analytics, Duluth, GA, USA. benjamin.cohen@stageanalytics.com.
FAU - Chingcuanco, Francine
AU  - Chingcuanco F
AD  - Stage Analytics, Duluth, GA, USA.
FAU - Zhang, Jingwei
AU  - Zhang J
AD  - CytoSorbents Corporation, Princeton, NJ, USA.
FAU - Reid, Natalie M
AU  - Reid NM
AD  - Stage Analytics, Duluth, GA, USA.
FAU - Lee, Victoria
AU  - Lee V
AD  - CytoSorbents Corporation, Princeton, NJ, USA.
FAU - Hong, Jonathan
AU  - Hong J
AD  - St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada.
FAU - Deliargyris, Efthymios N
AU  - Deliargyris EN
AD  - CytoSorbents Corporation, Princeton, NJ, USA.
FAU - Padula, William V
AU  - Padula WV
AD  - Stage Analytics, Duluth, GA, USA. padula@usc.edu.
AD  - Department of Pharmaceutical and Health Economics, School of Pharmacy, University 
      of Southern California, Los Angeles, CA, USA. padula@usc.edu.
AD  - The Leonard D. Schaeffer Center for Health Policy and Economics, University of 
      Southern California, USC Schaeffer Center, 635 Downey Way (VPD), Los Angeles, CA, 
      90089, USA. padula@usc.edu.
LA  - eng
PT  - Journal Article
DEP - 20230519
PL  - New Zealand
TA  - Am J Cardiovasc Drugs
JT  - American journal of cardiovascular drugs : drugs, devices, and other 
      interventions
JID - 100967755
RN  - GLH0314RVC (Ticagrelor)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Humans
MH  - Ticagrelor/adverse effects
MH  - *Platelet Aggregation Inhibitors/adverse effects
MH  - Fibrinolytic Agents/adverse effects
MH  - Cost-Benefit Analysis
MH  - Hemorrhage/chemically induced
MH  - Coronary Artery Bypass/adverse effects
MH  - *Acute Coronary Syndrome/drug therapy/surgery
PMC - PMC10328880
COIS- JZ, VL, and END are employees of CytoSorbents Corporation. BGC, FC, NMR, and WVP 
      provided consulting services to CytoSorbents Corporation for Stage Analytics; NMR 
      and WVP are equity holders of Stage Analytics.
EDAT- 2023/05/19 13:05
MHDA- 2023/07/10 06:42
PMCR- 2023/05/19
CRDT- 2023/05/19 11:14
PHST- 2023/04/20 00:00 [accepted]
PHST- 2023/07/10 06:42 [medline]
PHST- 2023/05/19 13:05 [pubmed]
PHST- 2023/05/19 11:14 [entrez]
PHST- 2023/05/19 00:00 [pmc-release]
AID - 10.1007/s40256-023-00587-4 [pii]
AID - 587 [pii]
AID - 10.1007/s40256-023-00587-4 [doi]
PST - ppublish
SO  - Am J Cardiovasc Drugs. 2023 Jul;23(4):429-440. doi: 10.1007/s40256-023-00587-4. 
      Epub 2023 May 19.