Abciximab provides cost-effective survival advantage in high-volume interventional practice.
BACKGROUND
Placebo-controlled randomized trials of platelet glycoprotein (GP) IIb/IIIa blockade during percutaneous coronary intervention have demonstrated efficacy of these agents for reducing the risk of periprocedural ischemic events. However, cost-effectiveness of this adjunctive pharmacotherapy has been scrutinized. Extrapolation of cost-efficacy observations from clinical trials to "real world" interventional practice is problematic.


METHODS
Consecutive percutaneous coronary interventions (n = 1472) performed by Ohio Heart Health Center operators at The Christ Hospital, Cincinnati, Ohio, in 1997 were analyzed for procedural and long-term (6-month) outcomes and charges. Observations on cost and efficacy (survival) were adjusted for nonrandomized abciximab allocation by means of "propensity scoring" methods.


RESULTS
Abciximab therapy was associated with a survival advantage to 6 months after percutaneous coronary intervention. The average reduction in mortality rate at 6 months was 3.4% (unadjusted) and 4.9% when adjusted for nonrandomization. The average charge increment to 6 months was $1512 (unadjusted) and $950 when adjusted for nonrandomization. Patients deriving the greatest reduction in mortality rates also had a reduction in total cardiovascular charges to 6 months. Distinguishing demographics of this population included multivessel coronary intervention, coronary stent deployment, intervention within 1 week of myocardial infarction, and lower left ventricular ejection fraction. The average cost per life-year gained in this study was $2875 for all patients (unadjusted) and $1243 when adjusted for nonrandomization.


CONCLUSIONS
Abciximab provides a cost-effective survival advantage in high-volume interventional practice that compares favorably with currently accepted standards. Clinical and procedural demographics associated with increased cost-effectiveness included multivessel coronary intervention, stent deployment, recent (<1 week) myocardial infarction, and impaired left ventricular function.
Kereiakes
D J
DJ
Carl and Edyth Lindner Center for Research and Education, Cincinnati, Ohio, USA.
Obenchain
R L
RL
Barber
B L
BL
Smith
A
A
McDonald
M
M
Broderick
T M
TM
Runyon
J P
JP
Shimshak
T M
TM
Schneider
J F
JF
Hattemer
C R
CR
Roth
E M
EM
Whang
D D
DD
Cocks
D
D
Abbottsmith
C W
CW
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D003327:Coronary Disease / Q000191:economics* / Q000401:mortality / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011379:Prognosis; D015996:Survival Rate / Q000639:trends
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab