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Abciximab. A pharmacoeconomic review of its use in percutaneous coronary revascularisation
1Adis International Limited, Auckland, New Zealand. demail@adis.co.nz
Insights
Abciximab, used with aspirin and heparin, significantly reduces ischaemic complications after percutaneous coronary revascularisation. This therapy is cost-effective, especially for high-risk patients and those receiving coronary stents.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Interventional Cardiology
Background:
- Abciximab is a glycoprotein IIb/IIIa inhibitor used to prevent platelet aggregation.
- It is administered with aspirin and heparin during percutaneous coronary revascularisation (PCR) to mitigate ischaemic events.
- Coronary heart disease patients undergoing PCR face significant risks of ischaemic complications.
Purpose of the Study:
- To evaluate the clinical efficacy and cost-effectiveness of abciximab in patients undergoing PCR.
- To assess the impact of abciximab on short-term and long-term ischaemic complications.
- To determine the economic viability of abciximab therapy across different patient risk profiles.
Main Methods:
- Analysis of large, well-designed clinical studies and meta-analyses.
- Prospective economic substudies and observational data collection.
- Subgroup analyses focusing on high-risk patients and those receiving coronary stents.
Main Results:
- Abciximab reduced ischaemic complications by 33-50% within 30 days post-PCR.
- Significant reductions in mortality were observed at 1 and 3 years, particularly in high-risk groups.
- Cost-effectiveness was demonstrated, especially in patients with unstable angina and those undergoing stenting.
Conclusions:
- Intravenous abciximab regimens are economically viable for patients undergoing PCR, irrespective of risk level.
- The drug is cost-effective in conjunction with coronary stents and shows enhanced cost-effectiveness in high-risk subgroups.
- Abciximab therapy offers significant clinical benefits and improved mortality outcomes.
Unlabelled:
Abciximab is a monoclonal antibody fragment that inhibits platelet aggregation through antagonism of glycoprotein IIb/IIIa. The drug is used in conjunction with heparin and aspirin to prevent ischaemic complications associated with percutaneous coronary revascularisation in patients with coronary heart disease. Large and well designed clinical studies have shown abciximab, as an adjunct to aspirin and heparin, to reduce by around one-third to one-half the incidence of ischaemic complications within 30 days of percutaneous coronary revascularisation. Use of the drug appears advantageous in patients at high risk, and abciximab also reduces complications in patients undergoing coronary stenting, although the drug does not appear to inhibit restenotic tissue volume within stents. Longer term benefit has also been reported, with emerging 1-year data from a study in patients at all levels of risk showing reductions in a composite end-point of death, myocardial infarction (MI) or urgent repeat revascularisation. Three-year benefit has been reported in high risk patients. Meta-analysis results, and 1-year data from patients receiving stents, have shown reduced mortality with abciximab. Abciximab therapy had an incremental cost over standard therapy from a hospital perspective of $US293 per patient (1991/1992 values) over 6 months in a prospective economic substudy from a major US clinical trial of the drug in high risk patients. Abciximab was cost saving in patients with unstable angina. A mean net cost of hospitalisation of $US476 per patients (1995 costs) has been shown in a further study in patients with a broad range of levels of risk, and observational data indicate reduced duration of hospitalisation with abciximab. Cost-effectiveness data favoured abciximab with aspirin and heparin over a 6-month period in Spanish and Dutch analyses in which data from the above trial were combined with local cost data, but not in an Australian analysis. Subgroup analyses have indicated enhanced cost effectiveness in high risk patients. Available data also show clinical benefit and cost effectiveness of abciximab therapy in conjunction with coronary stent placement.
Conclusions:
Data indicate intravenous bolus plus 12-hour infusion regimens of abciximab to be economically viable in patients at high or low risk of ischaemic complications after percutaneous coronary revascularisation. The drug has been shown to be cost effective in patients receiving the drug in conjunction with coronary stents, and subgroup analyses indicate additional cost effectiveness in certain groups of patients at high risk of ischaemic complications (notably those with acute MI and unstable angina).