Cost and effectiveness of glycoprotein IIb/IIIa-receptor inhibitors in patients with acute myocardial infarction undergoing percutaneous coronary intervention.
Outcomes in patients with acute myocardial infarction (AMI) who received adjunctive therapy with glycoprotein (GP) IIb/IIIa-receptor inhibitors during percutaneous coronary intervention (PCI) were studied. Data from a national all-payer database for the period from January 2000 to July 2001 were analyzed to compare in-hospital mortality, complications, incremental costs, and length of stay between AMI patients who did and did not receive a GP IIb/IIIa-receptor inhibitor during PCI. Risk adjustment was performed by logistic regression to account for differences in patient and institutional characteristics. Complications were evaluated as a composite of cardiac, noncardiac, procedural, and nonprocedural complications. Incremental costs and length of stay were analyzed by least-squares regression. A total of 32,529 patients in 99 hospitals were included. Only abciximab had a significant benefit for risk-adjusted mortality (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.59-0.92, p = 0.007) and shorter length of stay (0.21 day, 95% CI = 0.09-0.34 day, p = 0.0013) compared with the controls. Eptifibatide was associated with fewer complications (OR = 0.86, 95% CI = 0.75-0.98, p = 0.02), and tirofiban incurred the lowest incremental cost ($644, OR = $252-$1,036, p < 0.0001), but abciximab had the most favorable cost-effectiveness ratio ($14,515 per life-year gained). Information from a large database supported the use of GP IIb/IIIa-receptor inhibitors in patients with AMI undergoing PCI. Treatment with abciximab was associated with favorable differences in survival, cost-effectiveness, and length of stay compared to treatment without a GP IIb/IIIa-receptor inhibitor.
McCollam
Patrick L
PL
Lilly Research Laboratories, Eli Lilly & Co., Indianapolis, IN, USA. mccollam_patrick_l@lilly.com
Foster
David A
DA
Riesmeyer
Jeffrey S
JS
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D016022:Case-Control Studies; D016527:Drug Costs / Q000706:statistics & numerical data; D000077542:Eptifibatide; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; 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* / Q000191:economics; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab