title: Cost-effectiveness of platelet glycoprotein IIb/IIIa inhibition with eptifibatide in patients with non-ST-elevation acute coronary syndromes.
abstract: BACKGROUND
  In the PURSUIT trial, eptifibatide significantly reduced the 30-day incidence of death and myocardial infarction relative to placebo in 9461 patients with an acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction).
  
  
  RESULTS
  We conducted a 2-part prospective economic substudy of the 3522 US patients enrolled in PURSUIT: (1) an empirical intention-to-treat comparison of medical costs (hospital plus physician) up to 6 months after hospitalization and (2) a lifetime cost-effectiveness analysis. The base-case cost-effectiveness ratio was expressed as the 1996 US dollars required to add 1 life-year with eptifibatide therapy. The 2 treatment arms had equivalent resource consumption and medical costs (exclusive of the cost of the eptifibatide regimen) during the index (enrollment) hospitalization (P=0.78) and up to 6 months afterward (P=0.60). The average wholesale price of the eptifibatide regimen was $1217, but a typical hospital discounted price was $1014. The estimated life expectancy from randomization in the US patients was 15.96 years for eptifibatide and 15.85 years for placebo, an incremental difference of 0.111. The incremental cost-effectiveness ratio for eptifibatide therapy in US PURSUIT patients was $16 491 per year of life saved. This result was robust through a wide range of sensitivity analyses. The cost-utility ratio for eptifibatide (using time trade-off defined utilities) was $19 693 per added quality-adjusted life-year.
  
  
  CONCLUSIONS
  Based on the results observed in the US PURSUIT patients, the routine addition of eptifibatide to standard care for non-ST-elevation acute coronary syndrome patients is economically attractive by conventional standards.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. daniel.mark@duke.edu
authors.forename: D B
authors.initials: DB
authors.lastname: Mark
authors.forename: R A
authors.initials: RA
authors.lastname: Harrington
authors.forename: A M
authors.initials: AM
authors.lastname: Lincoff
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: C L
authors.initials: CL
authors.lastname: Nelson
authors.forename: A A
authors.initials: AA
authors.lastname: Tsiatis
authors.forename: H
authors.initials: H
authors.lastname: Buell
authors.forename: K W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: L
authors.initials: L
authors.lastname: Davidson-Ray
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D000789:Angina, Unstable / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D000077542:Eptifibatide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics; D010455:Peptides / Q000191:economics / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide