Abciximab provides cost-effective survival advantage in high-volume interventional practice
D J Kereiakes1, R L Obenchain, B L Barber
1Carl and Edyth Lindner Center for Research and Education, Cincinnati, Ohio, USA.
Insights
Platelet glycoprotein (GP) IIb/IIIa blockade with abciximab improves survival after percutaneous coronary intervention. This therapy is cost-effective, especially for high-risk patients, offering a survival advantage with favorable cost per life-year gained.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Economics
Background:
- Platelet glycoprotein (GP) IIb/IIIa inhibitors are effective in reducing ischemic events during percutaneous coronary intervention (PCI).
- The cost-effectiveness of GP IIb/IIIa blockade as adjunctive therapy in PCI remains a subject of scrutiny.
- Extrapolating trial-based cost-efficacy data to real-world practice presents challenges.
Purpose of the Study:
- To evaluate the cost-effectiveness of abciximab therapy in a real-world setting of percutaneous coronary intervention.
- To assess the impact of abciximab on procedural and long-term (6-month) survival and healthcare charges.
- To identify patient and procedural characteristics associated with improved cost-effectiveness.
Main Methods:
- Analysis of 1472 consecutive percutaneous coronary interventions performed in 1997.
- Utilized propensity scoring methods to adjust for nonrandomized abciximab allocation.
- Evaluated procedural outcomes, 6-month survival rates, and associated healthcare charges.
Main Results:
- Abciximab therapy demonstrated a survival advantage at 6 months post-PCI, with adjusted mortality reduction of 4.9%.
- The adjusted average charge increment associated with abciximab was $950 over 6 months.
- The adjusted cost per life-year gained was favorable at $1243, particularly in patients with multivessel intervention, stent deployment, recent myocardial infarction, or impaired left ventricular function.
Conclusions:
- Abciximab provides a cost-effective survival benefit in high-volume interventional cardiology practice.
- The therapy's cost-effectiveness favorably compares to established standards of care.
- Multivessel intervention, stent use, recent myocardial infarction, and impaired left ventricular function are associated with enhanced cost-effectiveness.
Background:
Placebo-controlled randomized trials of platelet glycoprotein (GP) IIb/IIIa blockade during percutaneous coronary intervention have demonstrated efficacy of these agents for reducing the risk of periprocedural ischemic events. However, cost-effectiveness of this adjunctive pharmacotherapy has been scrutinized. Extrapolation of cost-efficacy observations from clinical trials to "real world" interventional practice is problematic.
Methods:
Consecutive percutaneous coronary interventions (n = 1472) performed by Ohio Heart Health Center operators at The Christ Hospital, Cincinnati, Ohio, in 1997 were analyzed for procedural and long-term (6-month) outcomes and charges. Observations on cost and efficacy (survival) were adjusted for nonrandomized abciximab allocation by means of "propensity scoring" methods.
Results:
Abciximab therapy was associated with a survival advantage to 6 months after percutaneous coronary intervention. The average reduction in mortality rate at 6 months was 3.4% (unadjusted) and 4.9% when adjusted for nonrandomization. The average charge increment to 6 months was $1512 (unadjusted) and $950 when adjusted for nonrandomization. Patients deriving the greatest reduction in mortality rates also had a reduction in total cardiovascular charges to 6 months. Distinguishing demographics of this population included multivessel coronary intervention, coronary stent deployment, intervention within 1 week of myocardial infarction, and lower left ventricular ejection fraction. The average cost per life-year gained in this study was $2875 for all patients (unadjusted) and $1243 when adjusted for nonrandomization.
Conclusions:
Abciximab provides a cost-effective survival advantage in high-volume interventional practice that compares favorably with currently accepted standards. Clinical and procedural demographics associated with increased cost-effectiveness included multivessel coronary intervention, stent deployment, recent (<1 week) myocardial infarction, and impaired left ventricular function.
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