National economic impact of tirofiban for unstable angina and myocardial infarction without ST elevation; example from the United Kingdom.
BACKGROUND
Acute coronary syndromes without ST elevation are a major health and economic burden. Treatments such as glycoprotein IIb/IIIa antagonists like tirofiban reduce the risk of complications but the cost impact of these agents including cost offsets of avoiding complications are needed particularly in Europe.


METHODS
We used treatment patterns from the Prospective Registry of Acute Ischemic Syndromes in the UK, risk reductions derived from the PRISM-PLUS trial and cost estimates from the CHKS database to estimate the impact of tirofiban on PRAIS-UK patients with and without complications and subgroups at higher risk of complications. These subgroups (and proportions) were patients: (1) aged 60 or over with abnormal electrocardiograms (58%), (2) with ST depression or bundle branch block on admission (30%) and (3) with ST depression, bundle branch block or MI on admission (37%).


RESULTS
Total cost of care in the UK at 6 months for the estimated 87339 acute coronary syndromes admissions annually was pound 213 million, which would increase by pound 33 million (15.7%) if tirofiban were given to all patients, avoiding 2422 complications at a mean cost per event avoided of pound 13388. Among the subgroups, the mean cost per event avoided ranges from pound 10856 for subgroup 1 to pound 5953 for subgroup 3. Treating the latter subgroup, would avoid 1977 events at a cost of pound 12 million (5.5%).


CONCLUSIONS
The use of tirofiban in the UK to treat acute coronary syndromes patients without ST elevation provides an important therapeutic advantage at modest proportional increase in cost, particularly if targeted to higher risk subgroups as recommended in the European guidelines.
Bakhai
Ameet
A
Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. a.bakhai@rbh.nthames.nhs.uk
Flather
Marcus D
MD
Collinson
Julian R
JR
Stevens
Warren
W
Normand
Charles
C
Alemao
Evo
E
Itzler
Robbin
R
Ben-Joseph
Rami
R
D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D004562:Electrocardiography / Q000191:economics*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000191:economics / Q000453:epidemiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D010343:Patient Admission; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013577:Syndrome; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use*; D006113:United Kingdom / Q000453:epidemiology
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D006493:Heparin; D000077466:Tirofiban