Cost effectiveness of abciximab during routine medical practice.
OBJECTIVE
To estimate the cost per ischaemic event (death, nonfatal myocardial infarction, subsequent revascularisation procedure) avoided at 6 months in high risk patients undergoing coronary revascularisation treated with abciximab during routine medical care.


METHODS
Retrospective, matched cohort design.


METHODS
University teaching hospital.


METHODS
62 abciximab-treated patients and 62 patients not treated with abciximab with high risk coronary lesions were matched according to gender, hyperlipidaemia, diabetes mellitus and stenting.


METHODS
Using a third-party payer's perspective, an incremental cost-effectiveness ratio (ICER) was computed as the cost per ischaemic event avoided over 6 months. Fieller's theorem was used to estimate confidence sets and confidence ellipses were generated to visually represent the variability in the data.


RESULTS
At 6 months, abciximab-treated patients experienced an approximately 40% lower rate of ischaemic events (16.1 vs 27.4%; p = 0.128). The point estimate of the ICER was $US21,789 per ischaemic event avoided. Fieller's theorem resulted in a 95% confidence set consisting of 2 half-lines (-infinity to -$US115,461) and ($US391 to +infinity), reflecting the finding that the ICER denominator was not significantly different from zero at the p = 0.05 level.


CONCLUSIONS
In high risk patients treated during routine care, the effectiveness of abciximab was consistent with efficacy rates from clinical trials. However, abciximab-treated patients remained approximately $US2400 more costly at 6 months.
Reed
S O
SO
Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA. sdreed@u.washington.edu
Mullins
C D
CD
Magder
L S
LS
D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000191:economics / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000191:economics; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab