Variability in abciximab (ReoPro) prescribing: evidence based or budget driven?

Abciximab improves outcomes in patients undergoing percutaneous transluminal coronary intervention (PTCA). Clinicians, however, have expressed concerns that they do not have enough budget to administer abciximab to all eligible patients. We studied the patterns of prescribing of abciximab and identified factors that correlate with the level of usage.

In each of all 13 Dutch PTCA centres one opinion-leading cardiologist was approached to provide data on the abciximab prescribing in their centre and to co-operate in an interview on this topic. We performed linear regression analysis in which the level of abciximab prescribing was the dependent variable. Potential determinants investigated were the number of PTCAs performed, the criteria for abciximab prescribing, funding and possible financial restrictions, participation in clinical trials in the past, percentage stenting, and desired level of abciximab prescribing.

All 13 PTCA centres in the Netherlands participated in our study. The level of abciximab prescribing varied from 2 to 36% of all PTCAs. The criteria for patient selection significantly differed between centres. Together budget, investigatorship, size, and type of the institution were highly predictive for the level of abciximab prescribing (R2 = 0.93, p < 0.001). The more patients doctors had included in clinical trials in the past, the higher was the likelihood that they had prescribed abciximab.

Shortly after its introduction, patterns of abciximab prescribing varied widely between PTCA centres. There was no agreement on which patients to select for this preventive treatment. Budget and involvement in clinical trials in the past were important predictors of the level of prescribing in each centre.