(P-291) Global Antiplatelet Sales Trend: A Focus on P2Y12 Inhibitors from 2008 to 2018

Background: In combination with aspirin, P2Y12 inhibitors are an important component of dual antiplatelet therapy (DAPT). The 2016/2017 American and European guidelines prefer the use of ticagrelor or prasugrel over clopidogrel in DAPT for the prevention of atherothrombotic complications in patients with an acute coronary syndrome.

Objectives: To describe trends in the accessibility and affordability of P2Y12 inhibitors across countries with different income levels.

Methods: A descriptive study using aggregated pharmaceutical sales data from the IQVIA Multinational Integrated Data Analysis System (IQVIA-MIDAS) was conducted using data from 65 countries between 2008 to 2018. The volume of medicines sold to retail and hospital pharmacies was captured from wholesalers in different countries and unified to facilitate global-level analysis. Patient-level data is not available in IQVIA-MIDAS; hence this study was exempted from ethics approval by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster. Countries were stratified into 38 high-income countries and 27 middle-income countries according to the World Bank income classification 2018. We obtained population estimates from the UN World Population Prospects (2019 Report). Clopidogrel, ticagrelor, and prasugrel are the oral P2Y12 inhibitors examined in this study. Sales volume was expressed in standard units (SU) per year per person, and 1 SU was defined as a single tablet, capsule or ampoule/vial or 5 mL oral suspension. Data were analyzed using R (version 4.0.2).

Results: Overall, global sales of P2Y12 inhibitors increased from 0.80 SU per year per person in 2008 to 1.79 in 2018. Growth in sales of P2Y12 inhibitors was greater in middle-income countries (compound annual growth rate 356.93%) compared to high-income countries (compound annual growth rate 46.42%). Clopidogrel had the highest sales volume in both high-income and middle-income countries from 2008 to 2018. Ticagrelor sales volume increased mainly in high-income countries, while prasugrel remained low in both middle- and high-income countries.

Conclusions: Despite current guideline recommendations favoring ticagrelor and prasugrel for the prevention of atherothrombotic complications in patients with an acute coronary syndrome, clopidogrel retained the highest sales volume among the P2Y12 inhibitors from 2008 to 2018.