Prescribing Trends and Health Care Expenditure of P2Y₁₂ Prescriptions in Australia Over the Last Decade

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ticagrelor and guideline recommended P2Y₁₂ inhibitor after ACS, it represented the minority of scripts before being withdrawn.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.