OBJECTIVES: Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor indicated for the reduction of thrombotic cardiovascular events in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor prior to the PCI procedure, and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable.

The objective of this analysis is to estimate the UK budget impact of introducing cangrelor for patients with gastric absorption issues undergoing PCI.

METHODS: A budget impact model was developed to calculate the impact, to the UK National Health System (NHS), of introducing cangrelor to treat patients with gastric absorption issues undergoing PCI. The cangrelor-eligible population was estimated using 2023 UK hospital episode statistics (HES) and UK clinical expert advice. Efficacy (thrombotic events), safety (bleeding events), and cost data were based on clinical trials, literature and the British National Formulary.

In the base case, cangrelor uptake ranged from 10% to 30% in Year 1-5. Comparators in the base case were oral P2Y12 inhibitors (clopidogrel, prasugrel and ticagrelor), glycoprotein IIb/IIIa inhibitors (eptifibatide and tirofiban), and aspirin and heparin alone.

A one-way sensitivity analysis was conducted to assess the impact of different parameters on results.

RESULTS: The cangrelor-eligible population was estimated at 10,903 patients per year. Over 5 years, cangrelor leads to a small cost saving of -0.29%, varying from -£262,178 in year 1 to £174,220 in year 5.

This may lead to a total of 314 fewer hospital days and 190 clinical events avoided.

The results of the one-way sensitivity analysis suggest the model is most sensitive to bailout GPI usage, cost of bailout GPIs and cost of cangrelor.

CONCLUSIONS: Introducing cangrelor to patients with gastric absorption issues undergoing PCI in the UK may result in a small cost saving and reduced length of stay.