The economics of adjunctive therapies in coronary angioplasty: drugs, devices, or both?
BACKGROUND
Abciximab reduces the number of ischemic events in patients undergoing angioplasty compared to standard therapy. Coronary stenting reduces the need for repeat procedures. Abciximab or stents individually are considered cost effective interventions. There is a need to quantify the economic value of the combination of abciximab and stenting over stenting alone.


METHODS
A decision analytic model was developed incorporating the outcomes from the EPISTENT study. Costs from Canadian sources for hospitalization, procedures and medications were used. Life expectancy was estimated using a Markov model. Total expected costs and outcomes of the abciximab and stent vs. stent alone were compared in an incremental analysis. The perspective of the analysis was a Canadian teaching hospital.


RESULTS
The acquisition cost for abciximab was partially offset by reduced costs for managing clinical events resulting in a net incremental cost of 1,076 dollars per patient over one year (8,617 dollars combination vs. 7,541 dollars stent alone). This added cost was accompanied by a reduction in large MI or death by an absolute rate of 5.7% at one year (5.3% combination vs. 11.0% stent alone), yielding an incremental cost-effectiveness ratio of 18,877 dollars per death or large MI averted. The long-term survival gain was 0.15 to 0.37 years yielding an attractive incremental cost effectiveness ratio of 2,832 dollars to 7,173 dollars per life year gained.


CONCLUSIONS
The combination of abciximab and stenting versus stenting alone provides improved clinical outcomes at a very reasonable cost from the Canadian hospital perspective.
Oh
Paul I
PI
Division of Clinical Pharmacology, Sunnybrook and Women's and Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute University of Toronto, Ontario, Canada. oh.pauldr@torontorehab.on.ca
Cohen
Eric A
EA
Mittmann
Nicole
N
Seung
Soo Jin
SJ
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000379:methods; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003131:Combined Modality Therapy / Q000191:economics; D003327:Coronary Disease / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics / Q000627:therapeutic use*; D018803:Models, Economic; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000191:economics; D015607:Stents / Q000191:economics; D016019:Survival Analysis
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab