Study objective: Data from randomized controlled trials support a mortality benefit with ticagrelor versus clopidogrel among patients with acute myocardial infarction (AMI). Many healthcare 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, following a pharmacist-led discussion on outpatient co-payment costs for ticagrelor.
Design: Retrospective cohort study.
Setting: A tertiary care academic medical center.
Patients: Patients hospitalized with AMI 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%) switched to clopidogrel after cost discussion. The median monthly ticagrelor co-payment was $268.29 (interquartile range [IQR] $45-$350) for switchers, versus $18 (IQR $6-$24) for non-switchers (p<0.001). Patients with co-payments of $100/month or more were 3.4 times more likely to switch to clopidogrel (relative risk 3.41, 95% confidence interval 2.12 to 5.47), compared with patients with co-payments of less than $100/month.
Conclusions: Following a discussion of outpatient costs, half of patients with AMI switched from ticagrelor to clopidogrel when given the choice.
Keywords: P2Y12 inhibitor; acute coronary syndrome; acute myocardial infarction; clopidogrel; cost; ticagrelor.