OBJECTIVES: Ticagrelor, co-administered with acetylsalicylic acid, is a new antiplatelet therapy for patients with acute coronary syndrome (ACS) aimed at preventing thrombotic events [i.e., cardiovascular mortality, myocardial infarction (MI) and stroke]. The goal was to determine the cost per life year gained (LYG) for ticagrelor compared to current standard therapy (clopidogrel) using a cost-effectiveness analysis framework based on the published results from the Platelet Inhibition and Patient Outcomes (PLATO). METHODS: A Markov model framework was developed in order to evaluate the costs and benefits of ticagrelor over a lifetime time horizon. The clinical outcomes consisted of four health states: "MI", "Stroke", "All Cause Mortality" and "Recovered", with frequencies derived from the pivotal PLATO study at one year. These health states were extrapolated into the future via "Live" and "Die" scenarios. Resources and costs (2010 Canadian $) were obtained from the literature or public domain. A 5% discount rate was applied to all the cost and clinical inputs after the first year. RESULTS: An incremental cost effectiveness ratio (ICER) of $1125/LYG was determined. Probabilistic sensitivity analysis presented greater than 99% of all iterations resulting in an ICER less than $50,000/LYG. The economic model was most sensitive to the probability of death within one year of ticagrelor or clopidogrel treatment. CONCLUSIONS: Based on outcomes in the PLATO trial, the use of ticagrelor instead of clopidogrel for treatment of ACS in Canada is associated with an ICER of $1,125/LYG. OBJECTIVES:Diabetic nephropathy significantly increases the risk of cardiovascular disease (CVD) and end-stage renal disease (ESRD) in hypertensive patients. According to the AVOID study, the direct renin-inhibitor aliskiren, when added to losartan and optimal antihypertensive therapy in patients with hypertension, type 2 diabetes (T2DM) and diabetic nephropathy, significantly (pϭ0.001) reduced albuminuria by 20% over 6 months, as assessed by urinary albumin-creatinine ratio (UACR). This simulation examines the potential long-term clinical benefits and costs of add-on therapy with aliskiren in hypertensive patients with T2DM and diabetic nephropathy in Germany. METHODS: We developed a micro-simulation model to depict the progression to ESRD, measured by UACR levels over time.Patients at model entry were on maximal recommended doses of losartan and optimal antihypertensive therapy, and either continued this regimen or received aliskiren as an add-on therapy. In scenario analyses, different assumptions on the maintenance of the 20% UACR-reduction were made. Expected costs of pharmacotherapy and medical care were calculated based on German-specific sources over 10 years applying an annual discount rate of five percent. Sensitivity analyses were conducted to analyze the impact of different input parameters. RESULTS: Add-on therapy with aliskiren was projected to reduce the risk of ESRD by 1.8% and delay the onset of ESRD by 0.15 years assuming that t...