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Targeting patients undergoing angioplasty for thrombus inhibition: a cost-effectiveness and decision support model
W S Weintraub1, T D Thompson, S Culler
1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. bill@hp3.eushc.org
Insights
Glycoprotein IIb/IIIa blockers effectively prevent adverse events after angioplasty in high-risk patients. Targeted antiplatelet therapy can be cost-effective for patients with a higher probability of complications.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Glycoprotein IIb/IIIa blockers show efficacy in preventing post-angioplasty adverse events in high-risk individuals.
- Cost-effectiveness of antiplatelet therapy selection remains uncertain for these patients.
Purpose of the Study:
- To evaluate the cost-effectiveness of targeted antiplatelet therapy selection after coronary intervention.
- To identify patient subgroups who would benefit most from glycoprotein IIb/IIIa blocker therapy.
Main Methods:
- Analysis of 4962 patients undergoing coronary interventions (n=6062) from 1993-1995.
- Development of multivariate models to predict adverse events (death, myocardial infarction, revascularization).
- Cost-effectiveness analysis based on therapy targeting patients with >5% event probability.
Main Results:
- Targeting therapy to patients with >5% event probability reduced complications from 6.39% to 5.37%.
- This strategy increased costs by $261 per patient, equating to $25,504 per event prevented.
- The marginal cost per event prevented increased significantly when widening the patient selection criteria.
Conclusions:
- Antiplatelet therapy may offer cost savings for high-risk patients undergoing angioplasty.
- Therapy is likely not cost-effective for low-risk patients.
- Preventing adverse events in midrange-risk patients (5-7% event probability) may be acceptable.
Background:
In recent clinical trials, glycoprotein IIb/IIIa blockers have demonstrated effectiveness in preventing adverse events after angioplasty in high-risk patients. However, uncertainty exists regarding the cost-effective selection of patients to receive antiplatelet therapy.
Methods And Results:
All 4962 patients at Emory University Hospitals who underwent coronary intervention procedures (n=6062) from 1993 to 1995 were studied. Multivariate models to predict death and the composite of death, Q-wave and non-Q-wave myocardial infarction, and emergency additional revascularization were developed. Hospital costs and professional costs were determined. A cost-effectiveness analysis with therapy targeted to high-risk patients was performed. If patients with a >5% probability of events received antiplatelet therapy that reduced events by 24% and cost $1000, 40.1% of patients would receive therapy; complications would be reduced from 6.39% to 5.37%, and cost would increase $261 from $10343 to $10604, or $25504 per event prevented. The marginal cost per event prevented by moving from a 7% to a 5% probability of an event cutoff would be $57 799.
Conclusions:
For high-risk patients, there may be cost savings; for low-risk patients, therapy may not be cost effective; and for patients in the midrange (between 5% and 7% probability of an adverse event), events may be prevented at an acceptable level of cost.
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