A strategy to offset the extra cost of sirolimus-eluting stent in patients undergoing intervention for acute myocardial infarction.
OBJECTIVE
To obtain a quantitative estimate of the overall costs and cost effectiveness ratio of sirolimus-eluting stents (SES) implantation and tirofiban infusion compared to abciximab and bare metal stent (BMS) in patients undergoing primary intervention for acute ST segment elevation myocardial infarction (STEMI).


METHODS
In the attempt to make the unrestricted use of SES in STEMI patients affordable under the current European reimbursement system, between March 6, 2003, and April 23, 2004, 175 patients with STEMI were randomized to receive tirofiban infusion and SES versus abciximab and BMS as part of the STRATEGY trial. Costs and outcome were monitored for 2 years.


RESULTS
The cost of the index procedure was 9345 euros +/-2573 and 9657+/-2114 for the tirofiban+SES and abciximab+BMS group, respectively (P=0.048). At follow-up, the composite of death or myocardial infarction and the costs not related to target vessel revascularisation (TVR) did not differ in the two groups while the rate of TVR and the costs related to it were lower in the tirofiban+SES group. The overall 2-year cost of treating a patient in the tirofiban+SES group was 10,971 euros +/-4185 compared to 12,066 euros +/-4636 for the abciximab+BMS group (P=0.006). Halving the cost of abciximab resulted in higher initial hospital costs for the tirofiban+SES but overall cost neutrality over a 24-month time horizon.


CONCLUSIONS
Compared to abciximab+BMS, tirofiban infusion+SES implantation in STEMI patients was an economically dominant strategy, with an improved composite outcome and lower overall costs.
Valgimigli
Marco
M
Cardiovascular Institute, University of Ferrara, Ferrara, Italy. halondav@tx.technion.ac.il
Mittmann
Nicole
N
Cohen
David J
DJ
Campo
Gianluca
G
Isogai
Pierre K
PK
Seung
Soo Jin
SJ
Dulisse
Brian
B
Arcozzi
Chiara
C
Squasi
Paolo
P
Percoco
Gianfranco
G
Ferrari
Roberto
R
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics; D003363:Cost Control; D003362:Cost-Benefit Analysis; D054855:Drug-Eluting Stents / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000191:economics; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D018709:Statistics, Nonparametric; D015607:Stents / Q000191:economics*; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban; D020123:Sirolimus; D000077284:Abciximab