title: Assessing the value of newer pharmacologic agents in non-ST elevation patients: a decision support system application.
abstract: Newer pharmacologic agents have demonstrated significant clinical and economic benefit in high-risk percutaneous transluminal coronary angioplasty (PTCA) patients. However, the higher costs of these agents may prohibit their use in lower-risk coronary artery disease (CAD) populations. We developed a decision support system (DSS) to determine the level of clinical effectiveness these newer agents must exhibit to be either cost-neutral or cost-effective in non-ST elevation patients. Our DSS evaluated six month cumulative costs, increased years of life saved (YOLS), and lifetime cost-effectiveness. We found that these therapies can cost as much as $1500 and be cost-neutral at six months if they reduce the composite endpoint of death, myocardial infarction (MI), or revascularization by 15%, and they may cost as much as $3000 and be cost-effective if they reduce this endpoint by 10%.
authors.affiliation: Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: E D
authors.initials: ED
authors.lastname: Peterson
authors.forename: J G
authors.initials: JG
authors.lastname: Jollis
authors.forename: B E
authors.initials: BE
authors.lastname: Tardiff
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: J D
authors.initials: JD
authors.lastname: Knight
authors.forename: D B
authors.initials: DB
authors.lastname: Mark
mesh_terms: D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D003327:Coronary Disease / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D004360:Drug Therapy, Computer-Assisted; D004562:Electrocardiography; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D026712:Value of Life
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab