Abciximab provides cost-effective survival advantage in high-volume interventional practice

• Published in: The American heart journal Vol. 140; no. 4; pp. 603 - 610
• Main Authors: Kereiakes, Dean J., Obenchain, Robert L., Barber, Beth L., Smith, Andrew, McDonald, Mark, Broderick, Thomas M., Runyon, John Paul, Shimshak, Thomas M., Schneider, John F., Hattemer, Charles R., Roth, Eli M., Whang, David D., Cocks, Douglas, Abbottsmith, Charles W.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-10-2000; Elsevier
• Subjects: Angioplasty, Balloon, Coronary - mortality; Antibodies, Monoclonal - economics; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Coronary Disease - economics; Coronary Disease - mortality; Coronary Disease - therapy; Cost-Benefit Analysis; Female; Humans; Immunoglobulin Fab Fragments - economics; Immunoglobulin Fab Fragments - therapeutic use; Male; Medical sciences; Middle Aged; Ohio - epidemiology; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - economics; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Prognosis; Survival Rate - trends; Ohio; Human; Glycoprotein IIbIIIa; Costs; Abciximab; Prognosis; Treatment efficiency; Coronary artery; Instrumentation therapy; Cardiovascular disease; Exploration; Coronary heart disease; Survival; Antiplatelet agent; Percutaneous route; Treatment; Health economy; Inhibitor; Combined treatment; Public health; Biological receptor
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1067/mhj.2000.109647

Background Placebo-controlled randomized trials of platelet glycoprotein (GP) IIb/IIIa blockade during percutaneous coronary intervention have demonstrated efficacy of these agents for reducing the risk of periprocedural ischemic events. However, cost-effectiveness of this adjunctive pharmacotherapy has been scrutinized. Extrapolation of cost-efficacy observations from clinical trials to “real world” interventional practice is problematic. Methods Consecutive percutaneous coronary interventions (n = 1472) performed by Ohio Heart Health Center operators at The Christ Hospital, Cincinnati, Ohio, in 1997 were analyzed for procedural and long-term (6-month) outcomes and charges. Observations on cost and efficacy (survival) were adjusted for nonrandomized abciximab allocation by means of “propensity scoring” methods. Results Abciximab therapy was associated with a survival advantage to 6 months after percutaneous coronary intervention. The average reduction in mortality rate at 6 months was 3.4% (unadjusted) and 4.9% when adjusted for nonrandomization. The average charge increment to 6 months was $1512 (unadjusted) and $950 when adjusted for nonrandomization. Patients deriving the greatest reduction in mortality rates also had a reduction in total cardiovascular charges to 6 months. Distinguishing demographics of this population included multivessel coronary intervention, coronary stent deployment, intervention within 1 week of myocardial infarction, and lower left ventricular ejection fraction. The average cost per life-year gained in this study was $2875 for all patients (unadjusted) and $1243 when adjusted for nonrandomization. Conclusions Abciximab provides a cost-effective survival advantage in high-volume interventional practice that compares favorably with currently accepted standards. Clinical and procedural demographics associated with increased cost-effectiveness included multivessel coronary intervention, stent deployment, recent (<1 week) myocardial infarction, and impaired left ventricular function. (Am Heart J 2000;140:603-10.)