Related Experiment Videos
Abciximab: cost-effective survival advantage in clinical trials and clinical practice
1Carl and Edyth Lindner Center for Research and Education, and The Ohio Heart Health Center, Cincinnati, OH 45219, USA.
Insights
Adjunctive therapy with abciximab during percutaneous coronary intervention (PCI) significantly reduced mortality by 3.4% at 6 months. This platelet glycoprotein IIb/IIIa receptor blockade offers a cost-effective survival advantage in high-volume interventional practice.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Interventional Cardiology
Background:
- Platelet glycoprotein (GP) IIb/IIIa receptor antagonists reduce ischemic events in percutaneous coronary intervention (PCI) and acute coronary syndromes.
- Existing data on cost-effectiveness primarily stem from placebo-controlled trials, lacking real-world evidence from high-volume practices.
Purpose of the Study:
- To evaluate the real-world cost-effectiveness of adjunctive abciximab therapy in high-volume PCI practice.
- To analyze in-hospital and 6-month clinical outcomes and cumulative costs associated with abciximab use.
Main Methods:
- Analysis of 1472 consecutive PCI procedures at a single institution, with 70% receiving abciximab.
- Propensity score adjustment to account for non-randomized treatment allocation.
- Evaluation of cost-effectiveness based on cost per life year gained.
Main Results:
- Adjunctive abciximab therapy was associated with a significant 3.4% reduction in 6-month mortality.
- Abciximab demonstrated a favorable cost-effective survival advantage compared to standard therapy in high-volume settings.
- Multivessel intervention, stent deployment, recent myocardial infarction, and impaired left-ventricular function were linked to increased cost-effectiveness.
Conclusions:
- Adjunctive abciximab provides a cost-effective survival benefit in high-volume interventional cardiology practice.
- Real-world data support the economic value of abciximab in specific patient and procedural subgroups.
- Further analysis of cost-effectiveness in diverse clinical scenarios is warranted.
Abstract:
Adjunctive blockade of the platelet glycoprotein (GP) IIb/IIIa receptor during either percutaneous coronary intervention (PCI) or for patients who present with non-ST segment elevation acute coronary syndromes has demonstrated efficacy in reducing platelet-mediated adverse cardiovascular ischemic events. The three currently available agents (abciximab, eptifibatide, tirofiban) differ markedly in pharmacodynamic and pharmacokinetic profiles, receptor affinity, and cost. Although pharmacoeconomic substudies are available from placebo-controlled randomized trials of platelet GPIIb/IIIa blockade during PCI, "real-world" cost-effectiveness data from high-volume practice are lacking. Therefore, in-hospital and late (6-month) clinical outcomes and cumulative cost/charge data were analyzed on 1472 consecutive PCI procedures (70% received abciximab) performed by high-volume operators at a single institution.(1) Data were adjusted for lack of randomized treatment allocation with the use of a propensity scoring technique. Adjunctive abciximab therapy for PCI was associated with a significant (3.4%) reduction in mortality to 6 months. Based on the economic cost-effectiveness concept of cost per life year gained relative to standard therapy,(2,3) abciximab provided a cost-effective survival advantage in high-volume interventional practice that compares very favorably with currently accepted standards. Clinical and procedural demographics associated with increased cost-effectiveness include multivessel coronary intervention, stent deployment, recent (<1 week) myocardial infarction (MI), and impaired left-ventricular (LV) function.