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Cost-effectiveness analysis of abciximab: a Canadian hospital perspective
P J Zed1, L Frighetto, R Sunderji
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
Insights
Abciximab therapy reduces event rates in high-risk percutaneous transluminal coronary angioplasty (PTCA) patients but increases costs. The incremental cost-effectiveness ratio was $29,700 Canadian dollars per event-free patient at six months.
Area of Science:
- Cardiology
- Health Economics
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- High-risk patients undergoing PTCA may benefit from adjunctive therapies to reduce ischemic complications.
- Assessing the economic implications of novel therapies is crucial for healthcare resource allocation.
Purpose of the Study:
- To evaluate the cost-effectiveness of abciximab as an adjunct to PTCA in high-risk Canadian patients.
- To compare outcomes and costs between abciximab therapy and traditional PTCA practice.
Main Methods:
- A predictive decision analytic model was developed using published clinical and economic data.
- Costs reflected the Canadian healthcare system.
- High-risk patients were defined based on established clinical trial criteria.
- Treatment strategies included abciximab with heparin versus heparin alone, with outcomes assessed up to 6 months post-PTCA.
Main Results:
- Abciximab therapy resulted in a lower event rate (29%) compared to no abciximab (33%) at 6 months.
- Major bleeding was more frequent in the abciximab arm (4%) versus the no abciximab arm (1.6%).
- The average cost per patient was higher with abciximab ($3261 CAD) versus no abciximab ($2073 CAD), yielding an ICER of $29,700 CAD per event-free patient.
Conclusions:
- Abciximab adjunctive therapy reduces event rates in high-risk PTCA patients compared to traditional treatment.
- This reduction in events is associated with a significant increase in healthcare costs.
- The cost of abciximab was identified as the primary driver of the cost-effectiveness outcome in sensitivity analyses.
Objective:
To assess the cost-effectiveness of abciximab therapy versus traditional practice in high-risk patients receiving percutaneous transluminal coronary angioplasty (PTCA) from a Canadian hospital perspective.
Design:
A predictive decision analytic model using published clinical and economic evaluations, as well as costs of medical care in Canada.
Subjects:
High-risk PTCA patients as defined by the Evaluation of c7E3 for Prevention of Ischemic Complications trial and the c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina trial.
Interventions:
Two treatment strategies were compared: (1) abciximab 0.25 mg/kg intravenous bolus 10 minutes prior to PTCA followed by abciximab 10 micrograms/min intravenous infusion for 12 hours after the procedure, and (2) no abciximab adjunctive therapy at the time of PTCA. Both treatment strategies were combined with intravenous heparin up to 100 units/kg bolus pre-PTCA followed by bolus doses for 1 hour after PTCA per the protocol. Cumulative outcomes were considered up to 6 months after initial PTCA.
Results:
At 6 months, 29% of the patients in the abciximab treatment arm compared with 33% in the no abciximab arm achieved one of the primary events. The most common adverse event experienced was major bleeding at 4% in the abciximab treatment arm versus 1.6% in the no abciximab arm. The average cost per patient for each strategy was $3261 Can ($1 Can = $0.686 US) (abciximab arm) versus $2073 Can (no abciximab arm), resulting in an incremental cost-effectiveness ratio of $29,700 Can per event-free patient. In univariate sensitivity analyses, the only controllable factor that changed the results of the cost-effectiveness outcome was the cost of abciximab.
Conclusions:
Although the use of abciximab as an adjunct to PTCA results in a reduction in event rates in high-risk patients compared with traditional treatment, there is an increased cost associated with this strategy.
