Table 1

Relative risk	amount	source
Relative risk for clopidogrel use in a history of myocardial infarction to subsequent non-fatal myocardial infarction	0.42	21
Relative risk for the use of clopidogrel in a history of myocardial infarction to subsequent fatal myocardial infarction	0.72	22,23
Relative risk of fatal and nonfatal myocardial infarction with concomitant use of aspirin and prasugrel compared with concomitant use of aspirin and clopidogrel	0.81	24
Risk of gastrointestinal bleeding with prasugrel compared with clopidogrel	1.4	25
Risk of gastrointestinal bleeding with prasugrel and aspirin versus clopidogrel and aspirin	1.31	26
Risk of gastrointestinal bleeding with prasugrel	1.67	27
Risk of gastrointestinal bleeding with prasugrel and aspirin	2.08	27

Table 1: Relative risks used in the model

Table 2

Transmission probability/age	55-59	59-64	64-69	69-74	74-79	79-84	84-89	89-100	ref
Non-fatal heart attack in the first year to fatal heart attack	0.0348	0.0348	0.07	0.07	0.1054	0.1054	0.127	0.127	28,29

Non-fatal heart attack in the first year to fatal heart attack	0.1152	0.1152	0.1019	0.1019	0.0874	0.0874	0.0711	0.0711	28,29
Non-fatal heart attack years later to non-fatal heart attack	0.0179	0.0179	0.0185	0.0185	0.0178	0.0178	0.016	0.016	28,29
Non-fatal heart attack years later to fatal heart attack	0.0092	0.0092	0.0152	0.0152	0.0235	0.0235	0.034	0.034	28,29
Death from causes other than heart attack	0.0073	0.0073	0.02826	0.02826	0.12533	0.12533	0.13925	0.13925	28,29

Table 2: Age-dependent transition probabilities used in the model

Table 3

Cases	heart attack (first year)			heart attack (later years)
	total cost		total cost
Cost of hospitalization	22,618,000		-
Physician visits	3,065,300		1,848,300
ECG	1,882,800		418,400
Echocardiography	1,407,000		-
Exercise test	1,012,700		-
Laboratory tests	3,402,220		1,321,000
Medication Cost	26,478,069		4,515,780
total sum	Clopidogrel+	52,854,084		8,103,480
	Prasugrel+	51,092,229

Table 3: MI treatment costs in the first year and subsequent years at public tariffs (Rials per patient) [30,31,32]

Table 4

Cases	heart attack (first year)		heart attack (later years)
	total cost		total cost
Cost of hospitalization	115,688,000		-
Physician visits	16,939,300		9,689,300
ECG	3,245,400		721,200
Echocardiography	2,736,000		-
Exercise test	1,955,100		-
Laboratory tests	11,766,231		4,724,634
Medicines	26,478,169		4,515,780
total sum	+ Clopidogrel	171,896,095	19,209,294
	+ Prasugrel	2170,134,240

Table 4: MI treatment costs in the first year and subsequent years at private tariffs (Rials per patient) [30,31,32]

Table 5

	Prasugrel	Clopidogrel	Incremental results
QALY (0% Discount)	17.54	17.43	0.11
LY (0% Discount)	20.13	20.01	0.12
0% cost-public (Rials) (0% Discount)	233446743	234964173	1517431
0% cost-private (Rials) (0% Discount)	639007826	639029260	21434
Discounted QALY	10.62	10.55	0.067
Discounted LYG	12.26	12.19	0.073
Discounted cost- public (Rials)	159513528	161513050	1999522

Table 5: Outcomes Assessment Results (per patient)

Table 6

ICER for QALY (0% discount)	-29777847.33 (cost-saving)
ICER for QALY (discounted)	-13643818.38 (cost-saving)
ICER LYG (0% discount)	-12755656.55 (cost-saving)
ICER LYG (discounted)	-27325127.67 (cost-saving)

Table 6: ICERs for public tariffs

Tables at a glance

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

Figures at a glance

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Figure 5

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Figure 6

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Figure 8

FIGURE 1

Figure 1: Markove model

FIGURE 2

Figure 2: Tornado chart of one-way sensitivity analysis for incremental QALYs

FIGURE 3

Figure 3: Tornado chart of one-way sensitivity analysis for incremental LYG

FIGURE 4

Figure 4: Tornado chart of one-way sensitivity analysis for incremental cost (in Rials)

FIGURE 5

Figure 5: Probabilistic sensitivity analysis for cost-effectiveness ratio of QALY with public tariff

FIGURE 6

Figure 6: Probabilistic sensitivity analysis for cost-effectiveness ratio of LYG with public tariff

FIGURE 7

Figure 7: Cost-effectiveness chart

FIGURE 8

Figure 8: Cost-effectiveness acceptability curve