THE ECONOMICS OF ADJUNCTIVE THERAPIES IN CORONARY ANGIOPLASTY: DRUGS, DEVICES, OR BOTH?
Main Article Content
Keywords
abciximab, cost-effectiveness, percutaneous coronary intervention
Abstract
Background
Abciximab reduces the number of ischemic events in patients undergoing angioplasty compared to standard therapy. Coronary stenting reduces the need for repeat procedures. Abciximab or stents individually are considered cost effective interventions. There is a need to quantify the economic value of the combination of abciximab and stenting over stenting alone.
Methods
A decision analytic model was developed incorporating the outcomes from the EPISTENT study. Costs from Canadian sources for hospitalization, procedures and medications were used. Life expectancy was estimated using a Markov model. Total expected costs and outcomes of the abciximab and stent vs. stent alone were compared in an incremental analysis. The perspective of the analysis was a Canadian teaching hospital.
Results
The acquisition cost for abciximab was partially offset by reduced costs for managing clinical events resulting in a net incremental cost of $1,076 per patient over one year ($8,617 combination vs. $7,541 stent alone). This added cost was accompanied by a reduction in large MI or death by an absolute rate of 5.7% at one year (5.3% combination vs. 11.0% stent alone), yielding an incremental cost-effectiveness ratio of $18,877 per death or large MI averted. The long-term survival gain was 0.15 to 0.37 years yielding an attractive incremental cost effectiveness ratio of $2,832 to $7,173 per life year gained.
Conclusions
The combination of abciximab and stenting versus stenting alone provides improved clinical outcomes at a very reasonable cost from the Canadian hospital perspective
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