Correspondence Letter by Serebruany Regarding Article, “Cost-Effectiveness of Prasugrel Versus Clopidogrel in Patients With Acute Coronary Syndromes and Planned Percutaneous Coronary Intervention: Results From the Trial to Assess Improvement in Therapeuti

I read with interest the article by Mahoney et al1 suggesting the cost advantage of prasugrel over clopidogrel; however, I found 3 aspects of their article confusing. First, frequency of rehospitaliza-tions (Table 1 in their article) does not include extra cancers observed in the prasugrel arm of the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel (TRITON) trial. Considering the 27 % increase in new cancers (P0.031), the 36.8 % incidence of new solid cancers (P0.013), and the escalated delayed cancer risks after 4 months of therapy (especially dominant in women) that are clearly outlined in the available US Food and Drug Administration reports,2,3 cancer imbalance should be in-cluded for a fair cost comparison. The mortality rate was also higher for patients with solid cancers, with more deaths in patients with new solid cancers (37 versus 25) and with new and worse solid cancers (43 versus 28) in the prasugrel group.