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MARKET DYNAMICS, TREATMENT COSTS AND EVIDENCE-BASED POSITIONING OF ANTIPLATELET AGENTS IN ROMANIA: A NATIONAL SELL-OUT ANALYSIS (2022 – 2025)

ELENA-AURORA LICIU ¹, IULIAN SARBU ²*, GABRIELA ȘTEFAN ¹, MARINA IONELA NEDEA ¹, ALIN NICOLESCU ¹

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This study evaluated the Romanian market for antiplatelet agents and linked real-world consumption patterns to treatment costs and clinical evidence. A national aggregated sell-out dataset covering August 2022–July 2025 was analyzed for antiplatelet agents classified as B01AC. Products were grouped by active substance, brand, manufacturer, originator/generic status and prescription status. Costs per treatment scheme were estimated from the Romanian National Catalogue of Maximum Prices of Medicinal Products and realized retail prices. During August 2024 - July 2025, B01AC medicines accounted for 19.43 million packages and 378.27 million RON in manufacturer-level value, increasing by 4.57% and 7.19%, respectively, versus the pre- vious 12 months. Acetylsalicylic acid dominated volume and value, while clopidogrel and ticagrelor defined the main prescrip- tion segment. The first three brands represented 75.15% of value and the brand-level Herfindahl-Hirschman Index was 2767. Direct monthly cost ranged from approximately 22 RON for acetylsalicylic acid to 358 RON for dual therapy with ticagrelor 90 mg. These findings show a concentrated, cost-sensitive market requiring patient-level pharmacy data to evaluate persistence, switching and guideline alignment. Ticagrelor represented only 1.09% of packages but 12.36% of manufacturer-level value, and the estimated annual cost of acetylsalicylic acid plus ticagrelor was approximately 4.2-fold that of acetylsalicylic acid plus clopidogrel.