Costs and effects of combining stenting and abciximab (ReoPro) in daily practice.
OBJECTIVE
The combined use of stents and abciximab in percutaneous coronary intervention has been evaluated in the EPISTENT trial. However, the clinical and economic findings in trials are not necessarily generalisable to a general population setting. We conducted a study in daily clinical practice comparing stented and non-stented patients undergoing coronary angioplasty with abciximab administration. Furthermore, we compare our results with the findings of the EPISTENT trial.


METHODS
From 1995 to 1999, refractory unstable patients scheduled for angioplasty and receiving abciximab in a Dutch regional hospital were followed prospectively for 6 months. Total costs were considered in addition to 2 composite clinical endpoints: (1) death or myocardial infarction (MI); and (2) death, MI, or any revascularisation procedure (major adverse cardiac events, MACE).


RESULTS
Stented patients (N=101) experienced less MACE than non-stented patients (N=83) (6.9% vs. 16.9%, OR=0.37, P=0.04). The total costs were similar for stented and non-stented patients (EUR 7 844 vs. EUR 7 904, P=0.93). Adjustment for baseline characteristics yielded similar results, although significance subsided. The relative risk reduction of 44% that we found, closely resembles the 42% that was found in the EPISTENT trial.


CONCLUSIONS
In everyday practice, as in the EPISTENT trial, the addition of a stent to abciximab treatment does seem to reduce the risk of MACE by about 40% at no additional costs.
Zwart-van Rijkom
J E
JE
Utrecht University, Department of Pharmaco-epidemiology and Pharmacotherapy, Utrecht, The Netherlands. J.E.F.Zwart-vanRijkom@pharm.uu.nl
Klungel
O H
OH
Leufkens
H G
HG
Broekmans
A W
AW
Schrijver-van Velthoven
S
S
Umans
V A
VA
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003327:Coronary Disease / Q000628:therapy*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D009426:Netherlands; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D011446:Prospective Studies; D015607:Stents / Q000191:economics
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab