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Cost-efficacy in interventional cardiology; results from the EPISTENT study. Evaluation of Platelet IIb/IIIa
J E Zwart-van Rijkom1, B A van Hout
1Erasmus University, Institute for Medical Technology Assessment, Rotterdam, The Netherlands.
Insights
The EPISTENT study found that combining abciximab with stenting after percutaneous transluminal coronary angioplasty (PTCA) improves survival. This strategy is cost-effective, particularly for diabetic patients, potentially saving costs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Economics
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Adjunctive therapies like abciximab and coronary stenting aim to improve PTCA outcomes.
- The EPISTENT trial evaluated the efficacy of combining abciximab and stenting.
Purpose of the Study:
- To assess the cost-effectiveness of combining abciximab and stenting compared to using either therapy alone as an adjunct to PTCA.
- To analyze the economic implications of improved event-free survival in patients undergoing PTCA.
Main Methods:
- Utilized 6-month efficacy data from the EPISTENT study.
- Integrated Dutch estimates of unit costs for medical procedures and therapies.
- Performed cost-effectiveness analysis comparing different treatment strategies.
Main Results:
- Combining abciximab with stenting after PTCA reduces major adverse cardiac events (MACE).
- The cost per additional MACE-free survivor was approximately Euros 13,000.
- In diabetic patients, this strategy showed improved revascularization rates and potential cost savings.
Conclusions:
- The combination of stenting and abciximab is a cost-effective strategy to improve outcomes after PTCA.
- For diabetic patients, this combined approach may lead to cost savings.
- The findings support the use of combined abciximab and stenting in selected patient populations.
Aims:
The EPISTENT study has demonstrated that the combined use of abciximab and stenting as an adjunct to PTCA leads to increased event-free survival compared to either using abciximab or stenting alone. However, this combined strategy may be costly and the additional costs have to be weighted against the additional effects.
Method And Results:
The 6-months efficacy data from the EPISTENT study are combined with Dutch estimates of unit costs. Adding a stent to a procedure with abciximab further decreases the number of revascularizations at an extra cost of Euros 12,000 (95% upper limit (u.l.) Euros 31,000) per additional major adverse cardiac event-free survivor. Adding abciximab to a stenting procedure decreases the incidence of myocardial infarctions at an extra cost of Euros 13,000 (95% u.l. Euros 27,000) per additional myocardial infarction-free survivor. In the subgroup of diabetics, adding abciximab improves revascularization rates as well, resulting in a cost-efficacy rate of Euros 2000 (95% u.l. Euros 25,000) per additional MACE-free survivor, with uncertainty regions indicating potential costs savings.
Conclusion:
The combination of stenting and abciximab costs about Euros 13,000 to avoid one event after PTCA. In diabetic patients the strategy may be cost-saving.
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