The Effectiveness and Profitability of Different Antithrombotic Therapy Regimens in Patients with Type 2 Diabetes Mellitus During 1 Year of Follow-Up after an Exacerbation of Coronary Heart Disease According to the Study ORACLE II

Aim    To analyze the efficacy and cost-effectiveness of various options of antithrombotic therapy in patients with type 2 diabetes mellitus (T2DM) after acute coronary syndrome (ACS), based on the results of a one-year follow-up.
Material and methods    The article presents features of various antithrombotic therapies in patients with T2DM after ACS from the standpoint of efficacy and cost-effectiveness in real clinical practice based on the materials of the ORACLE II open prospective observational study (2014-2017). The data of 368 patients were divided into three groups based on the selected antithrombotic therapy. Due to the identified significant differences in the clinical characteristics among these groups, the propensity score matching was used to reach a balance between the groups by key differing indicators: gender, age, hemoglobin concentration upon admission, and the frequency of percutaneous coronary intervention during the index hospitalization. 
Results    Based on adjusted data, it was noted that the patients taking ticagrelor had fewer adverse cardiovascular outcomes during the observation period after the index event: 9 (17.6%) vs. 21 (41.2%) and 14 (27.5%) in patients taking clopidogrel or during de-escalation of the antithrombotic therapy, respectively (p=0.031). The pharmacoeconomic analysis assessed the cost-effectiveness of each type of antithrombotic therapy. The costs of drugs during the follow-up period were higher in patients taking ticagrelor: 2,723,703.45 vs. 445,880.76 in those taking clopidogrel. Nevertheless, in the conditions of real clinical practice in the Russian Federation, an economic advantage of the ticagrelor treatment during long-term follow-up was a subsequent decrease in the number of hospitalizations and, consequently, a reduction in direct medical costs of the care covered by the compulsory medical insurance. The total costs of subsequent hospitalizations due to adverse cardiovascular events for one year of follow-up were 755,773.47 for patients taking ticagrelor and 2,209,545.53 for those taking clopidogrel. Thus, the total costs per person for one year of follow-up after the index event were 14,819.09 in the ticagrelor group and 43,324.42 in the clopidogrel group. 
Conclusion    In the conditions of real clinical practice in the Russian Federation, ticagrelor is currently a more effective antiplatelet drug than clopidogrel both in terms of preventing further adverse cardiovascular events and economic feasibility in patients with acute coronary syndrome and type 2 diabetes mellitus. 

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