NICE recommends £2-a-day anti-clotting drug to prevent heart attacks and strokes

In draft guidance published today, Anglo-Swedish pharma major AstraZeneca’s (LSE: AZN) Brilique (ticagrelor) has been recommended for National Health Service use by the medicines cost-effectiveness watchdog for England and Wales.

The National Institute for Health and Care Excellence (NICE) is proposing the use of the anti-clotting drug ticagrelor 60mg with aspirin for people who have had a heart attack.

A higher dose of ticagrelor is already recommended for 12 months after a heart attack. Now new draft guidance is recommending it is continued in these people at a lower dose for a further three years to reduce their risk of a further heart attack or stroke.

People who have had a heart attack are at higher risk of having a further heart attack or stroke. Current preventive treatment includes making lifestyle changes such as exercise, stopping smoking and eating a healthier diet. It also includes the use of anti-clotting drugs (antiplatelets), including aspirin, to reduce the risk of blood clots forming. In 2012/13 there were around 140,000 hospital admissions for heart attacks in England.

This draft guidance looks at the use of ticagrelor at a lower dose beyond the initial 12 month period as a continuation of their previous ticagrelor treatment. It recommends ticagrelor 60mg, which costs about £1 ($1.30) per tablet, with aspirin, taken twice a day for up to three years for people who have had a heart attack at least 12 months ago and who remain at high risk of having a further heart attack or stroke. The draft guidance states there should no interruption between treating at the higher 90mg dose and the lower 60mg dose.

The incremental cost-effectiveness ratio (ICER) for ticagrelor in combination with aspirin compared with aspirin alone was £20,636 ($26,827) per quality-adjusted life year (QALY) gained (incremental costs £1,432, incremental QALYs 0.069).

“Despite the availability of effective secondary prevention treatments as many as a quarter of people who have had a heart attack go on to have another heart attack or stroke – often with devastating consequences,” said Carole Longson, director of the NICE Health Technology Evaluation Centre.

Professor Longson added: “Fear of a recurrence can have a significant negative impact on a person’s quality of life. The evidence shows that ticagrelor, in combination with aspirin, is effective at reducing the risk of further heart attacks and strokes in people who have already had a heart attack. In provisionally recommending ticagrelor we are pleased to be able to increase the treatment options available to the many thousands of people who stand to benefit from it.”

Because there is limited data on ticagrelor’s efficacy and safety, particularly the risk of bleeding, beyond three years, the draft guidance does not recommend treatment with ticagrelor beyond that period. The draft guidance is now out for consultation until September 5, and will be fully considered by the committee at its meeting on September 14 and following this meeting the next draft guidance will be issued.