Use and Costs of P2Y12 Inhibitors After Acute Myocardial Infarction

This study uses a series of descriptive observational analyses conducted using German and US healthcare claims data, the CMS Open Payments database, and Medicare Part D prescribing data by national provider identifier. Patient-level analyses will use new-user cohort study designs conducted separately in German and US administrative healthcare claims databases. These analyses will evaluate temporal trends in the age- and sex-standardized initiation of clopidogrel, ticagrelor, and prasugrel among adults initiating outpatient P2Y12 inhibitor therapy after acute myocardial infarction and describe these trends in the context of the evolving evidence base and guideline recommendations. In addition, patient-level analyses will assess temporal trends in 12-month treatment costs, as well as population-level trends in major adverse cardiovascular events and bleeding-related hospitalizations among P2Y12 inhibitor initiators in Germany. Separate US-based analyses will evaluate industry payments associated with ticagrelor and prasugrel reported in the CMS Open Payments database and provider-level prescribing patterns according to receipt of ticagrelor-associated industry payments using linked Medicare Part D prescribing data. Eligible cohort entry dates for patient-level analyses will range from 2011 through 2024. PATIENT-LEVEL COHORT ANALYSES Inclusion Criteria * Adults aged ≥18 years * Acute myocardial infarction * Initiation of outpatient treatment with clopidogrel, ticagrelor, or prasugrel Exclusion Criteria * Prior use of clopidogrel, ticagrelor, or prasugrel * Initiation of more than one study drug on the cohort entry date * Missing age or sex information * Insufficient baseline claims enrollment TICAGRELOR-TO-PRASUGREL COST-SAVING ANALYSIS IN THE UNITED STATES Eligibility Criteria * Adults aged ≥18 years * Acute myocardial infarction * Initiation of outpatient treatment with ticagrelor INDUSTRY PAYMENT ANALYSIS IN THE UNITED STATES Eligibility Criteria * General and research payment records in the CMS Open Payments database * Ticagrelor or prasugrel listed as the associated drug PROVIDER-LEVEL PRESCRIBING ANALYSIS Eligibility Criteria * US Medicare Part D providers * \>10 ticagrelor or prasugrel claims during both the baseline period (2020-2021) and outcome period (2022-2023).