[An economic assessment of the use of abciximab as a coronary angioplasty preparation in the Italian health-care context].
Drugs blocking platelet glycoprotein IIb/IIIa receptors (anti-GP IIb/IIIa) have been used effectively to prevent thrombotic events after percutaneous transluminal coronary angioplasty (PTCA). However, the high cost of these drugs calls for an economic evaluation before they can be used systematically within the context of the Italian health-care system.


METHODS
The systematic review of three studies (EPIC, EPILOG, CAPTURE) that evaluated the effectiveness of abciximab (the only anti-GP IIb/IIIa drug commercially available in Italy) demonstrated that this drug can prevent thrombotic events (death, myocardial infarction, repeated PTCA, bypass surgery) at six months after PTCA (RR 0.84; IC 95% 0.77-0.91; number needed to treat for the composite end-point 21). We performed an economic evaluation of the use of abciximab, taking into account the cost the drug (2,561,100 Italian lire [ITL]/patient) and the number of events prevented. We calculated the mean cost-effectiveness ratio (cost of each patient without events at six months after PTCA), the incremental cost-effectiveness ratio (cost of each event prevented at six months after PTCA) and the cost of each year of life saved at six months after PTCA.


RESULTS
The mean cost-effectiveness ratio was 16.6 million ITL/patient (versus 15.4 million ITL/patient without the use of the drug); the incremental cost-effectiveness ratio was 34.3 million ITL/event prevented; the cost of each year of life saved was 32.3 million ITL.


CONCLUSIONS
With abciximab preventing thrombotic events at six months after PTCA, the cost of each patient without events and the cost of each event prevented at six months are within the range of other pharmaceutical procedures in cardiology (e.g. thrombolysis in acute myocardial infarction with tissue plasminogen activator). Our analysis supports the case for the systematic use of abciximab in patients undergoing PTCA.
Lorenzoni
R
R
UO Malattie Cardiovascolari, Ospedale Campo di Marte, Lucca.
Mazzotta
G
G
Gensini
G F
GF
De Caterina
R
R
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000379:methods; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000191:economics / Q000401:mortality / Q000628:therapy; D016527:Drug Costs; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab