Abciximab therapy in percutaneous intervention: economic issues in the United States

Whether abciximab therapy should be the standard of care during percutaneous intervention in the United States depends on its efficacy, safety, and economics. In view of the EPIC, CAPTURE, and EPILOG data, few question the superior efficacy and relative safety of abciximab compared with conventional high-dose heparin therapy during percutaneous intervention. Economic considerations have been the major issue limiting its use. Review of the economic data demonstrates that the incremental direct medical care cost of abciximab therapy is $290 to $600 per patient treated in the EPIC and EPILOG populations. In the patients with acute myocardial infarction and unstable angina, abciximab appears to reduce direct medical costs (produce cost savings) at 6 months. Given abciximab's significant incremental effectiveness, its relatively small incremental cost yielded a highly cost-effective therapy in the EPIC and EPILOG patient populations. Additional economic issues relate to minimizing bleeding complications, indirect costs, reduced frequency of emergency procedures, and rationalizing provider/payor policies and incentives to produce the optimal individual patient and societal outcomes. The currently available data concerning the efficacy, safety, and cost provide a compelling argument for embracing abciximab therapy in the treatment of patient subsets where it will be a cost-saving or cost-neutral adjunct to percutaneous coronary intervention. In other subsets, the direct medical cost will likely not be fully recouped, but the incremental cost-effectiveness will compare favorably to other widely accepted therapies.