Targeting patients undergoing angioplasty for thrombus inhibition: a cost-effectiveness and decision support model.
BACKGROUND
In recent clinical trials, glycoprotein IIb/IIIa blockers have demonstrated effectiveness in preventing adverse events after angioplasty in high-risk patients. However, uncertainty exists regarding the cost-effective selection of patients to receive antiplatelet therapy.


RESULTS
All 4962 patients at Emory University Hospitals who underwent coronary intervention procedures (n=6062) from 1993 to 1995 were studied. Multivariate models to predict death and the composite of death, Q-wave and non-Q-wave myocardial infarction, and emergency additional revascularization were developed. Hospital costs and professional costs were determined. A cost-effectiveness analysis with therapy targeted to high-risk patients was performed. If patients with a >5% probability of events received antiplatelet therapy that reduced events by 24% and cost $1000, 40.1% of patients would receive therapy; complications would be reduced from 6.39% to 5.37%, and cost would increase $261 from $10343 to $10604, or $25504 per event prevented. The marginal cost per event prevented by moving from a 7% to a 5% probability of an event cutoff would be $57 799.


CONCLUSIONS
For high-risk patients, there may be cost savings; for low-risk patients, therapy may not be cost effective; and for patients in the midrange (between 5% and 7% probability of an adverse event), events may be prevented at an acceptable level of cost.
Weintraub
W S
WS
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. bill@hp3.eushc.org
Thompson
T D
TD
Culler
S
S
Boccuzzi
S J
SJ
Becker
E R
ER
Kosinski
A S
AS
Mahoney
E
E
D017130:Angioplasty / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D003657:Decision Making; D006801:Humans; D015233:Models, Statistical; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000191:economics*; D011183:Postoperative Complications / Q000517:prevention & control; D013927:Thrombosis / Q000191:economics* / Q000517:prevention & control*
D010975:Platelet Aggregation Inhibitors