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Dirigirse a pacientes sometidos a angioplastia para la inhibición de trombos: un modelo de costo-efectividad y apoyo

W S Weintraub¹, T D Thompson, S Culler

¹Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. bill@hp3.eushc.org

|July 25, 2000

Resumen

Los bloqueadores de la glicoproteína IIb/IIIa previenen eficazmente los eventos adversos después de la angioplastia en pacientes de alto riesgo. La terapia antiplaquetaria dirigida puede ser rentable para pacientes con una mayor probabilidad de complicaciones.

Área de la Ciencia:

Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
Economía de la salud Economía de la salud
Cardiología Intervencionista Cardiología intervencionista.

Sus antecedentes:

Los bloqueadores de la glicoproteína IIb/IIIa muestran eficacia en la prevención de eventos adversos después de la angioplastia en individuos de alto riesgo.
La relación costo-efectividad de la selección de la terapia antiplaquetaria sigue siendo incierta para estos pacientes.

Objetivo del estudio:

Evaluar la rentabilidad de la selección de la terapia antiplaquetaria dirigida después de la intervención coronaria.
Para identificar los subgrupos de pacientes que se beneficiarían más de la terapia con bloqueadores de glicoproteína IIb/IIIa.

Principales métodos:

Análisis de 4962 pacientes sometidos a intervenciones coronarias (n=6062) entre 1993 y 1995.
Desarrollo de modelos multivariados para predecir eventos adversos (muerte, infarto de miocardio, revascularización).
Análisis de costo-efectividad basado en la terapia dirigida a pacientes con >5% de probabilidad de evento.

Principales resultados:

La terapia dirigida a pacientes con una probabilidad de evento >5% redujo las complicaciones de 6.39% a 5.37%.
Esta estrategia aumentó los costos en $ 261 por paciente, lo que equivale a $ 25,504 por evento prevenido.
El costo marginal por evento prevenido aumentó significativamente cuando se ampliaron los criterios de selección de pacientes.

Conclusiones:

La terapia antiplaquetaria puede ofrecer ahorros de costos para los pacientes de alto riesgo que se someten a angioplastia.
Es probable que la terapia no sea rentable para los pacientes de bajo riesgo.
La prevención de eventos adversos en pacientes de riesgo intermedio (probabilidad de evento del 5-7%) puede ser aceptable.

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