Key result
Eptifibatide matches abciximab for 1-year MACE while cutting drug costs by ~87%.
Why the study?
Does eptifibatide improve clinical outcomes and reduce costs compared to abciximab in patients with STEMI undergoing primary PCI?
Cohort (n=3,863)
No
Does eptifibatide improve clinical outcomes and reduce costs compared to abciximab in patients with STEMI undergoing primary PCI?
Eptifibatide provides a safe, equally effective, and significantly more cost-effective alternative to abciximab for patients with STEMI undergoing primary PCI.
May support eptifibatide as a lower-cost option in STEMI PCI; observational data leave open need for RCT confirmation.
INTRODUCTION: Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. There are few studies directly comparing these agents. The aim of this study was to assess whether eptifibatide is a safe and cost-effective alternative to abciximab in the treatment of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. METHODS: This was an observational cohort study of 3863 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention from 2007 to 2014. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. Time to first major adverse cardiac event defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization, and total hospital costs were compared between the groups. RESULTS: In all, 1741 patients received abciximab with 2122 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous MI/percutaneous coronary intervention and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan-Meier analysis revealed no significant difference in the 1-year event rates between patients given eptifibatide versus abciximab (p = 0.201). Age-adjusted Cox analysis demonstrated no difference in 1-year outcome between abciximab and eptifibatide (hazard ratio: 0.83; 95% confidence interval: 0.73-1.39), which persisted after multivariate adjustment (hazard ratio: 0.92; 95% confidence interval: 0.79-1.56) including the incorporation of a propensity score (hazard ratio: 0.88; 95% confidence interval: 0.71-1.44). Eptifbatide was associated with significant cost savings being 87% cheaper overall compared to abciximab (on average £650 cheaper per patient and saving approximately £950,000). CONCLUSION: This observational data suggest that eptifibatide is associated with similar outcomes and significant cost savings compared to abciximab when used in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
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Rathod et al. (2017) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=3,863). Eptifibatide vs. Abciximab was evaluated on First major adverse cardiac event (death, non-fatal myocardial infarction, stroke or target vessel revascularization) at 1 year (HR 0.88, 95% CI 0.71-1.44). Eptifibatide was associated with similar 1-year major adverse cardiac event rates compared to abciximab (HR 0.88, 95% CI 0.71-1.44) but resulted in 87% lower costs.
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