Key result
Abciximab yields ~4 percentage points fewer primary events at 6 months during PTCA despite increased bleeding.
Why the study?
The cost-effectiveness of abciximab therapy versus traditional practice in high-risk PTCA patients from a Canadian hospital perspective was not established.
Absolute Event Rate: 29% vs 33%
Abciximab may be cost-effective in high-risk PTCA from a Canadian hospital view; leaves open practice adoption pending prospective data.
OBJECTIVE: To assess the cost-effectiveness of abciximab therapy versus traditional practice in high-risk patients receiving percutaneous transluminal coronary angioplasty (PTCA) from a Canadian hospital perspective. DESIGN: A predictive decision analytic model using published clinical and economic evaluations, as well as costs of medical care in Canada. SUBJECTS: High-risk PTCA patients as defined by the Evaluation of c7E3 for Prevention of Ischemic Complications trial and the c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina trial. INTERVENTIONS: Two treatment strategies were compared: (1) abciximab 0.25 mg/kg intravenous bolus 10 minutes prior to PTCA followed by abciximab 10 micrograms/min intravenous infusion for 12 hours after the procedure, and (2) no abciximab adjunctive therapy at the time of PTCA. Both treatment strategies were combined with intravenous heparin up to 100 units/kg bolus pre-PTCA followed by bolus doses for 1 hour after PTCA per the protocol. Cumulative outcomes were considered up to 6 months after initial PTCA. RESULTS: At 6 months, 29% of the patients in the abciximab treatment arm compared with 33% in the no abciximab arm achieved one of the primary events. The most common adverse event experienced was major bleeding at 4% in the abciximab treatment arm versus 1.6% in the no abciximab arm. The average cost per patient for each strategy was $3261 Can ($1 Can = $0.686 US) (abciximab arm) versus $2073 Can (no abciximab arm), resulting in an incremental cost-effectiveness ratio of $29,700 Can per event-free patient. In univariate sensitivity analyses, the only controllable factor that changed the results of the cost-effectiveness outcome was the cost of abciximab. CONCLUSIONS: Although the use of abciximab as an adjunct to PTCA results in a reduction in event rates in high-risk patients compared with traditional treatment, there is an increased cost associated with this strategy.
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Frighetto et al. (1998) studied High-risk patients receiving percutaneous transluminal coronary angioplasty (PTCA). Abciximab vs. No abciximab adjunctive therapy at the time of PTCA was evaluated on primary events. Abciximab as an adjunct to PTCA reduced primary events at 6 months (29% vs 33%) but increased major bleeding (4% vs 1.6%), yielding an ICER of $29,700 CAD per event-free patient.
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