Use of abciximab (c7E3 Fab, ReoPro) as an adjunct to balloon angioplasty

OBJECTIVE: To estimate the magnitude of the clinical benefits that may resu lt from use of abciximab at the time of angioplasty and the cost of achievi ng them. DATA SOURCES: Four published randomized control trials. DATA SYNTHESIS: Meta-analysis of outcomes at six months. RESULTS: Use of abciximab in comparable high risk populations, in the manne r described in these trials, is estimated to have the following effects: It does not influence mortality within the first six months. It reduces the r ate of myocardial infarction (MI) by 3.3/100 treatments with a 95% CI of 1. 6 to 5.2. It may reduce the need for revascularization (angioplasty or coro nary artery bypass graft) by 2.1/100 treatments (95% CI-1.0 to 5.0). It doe s not cause any significant increase in major hemorrhagic events. There is no evidence that it influences restenosis rates. The net cost per MI preven ted would be approximately $44,000, ranging from approximately $29,000 to $ 71,000 on sensitivity analysis. The net cost per adverse event prevented (M I plus revascularization procedure) would be approximately $27,000 (sensiti vity analysis $16,000 to $57,000). Use of abciximab for all of the approxim ately 17,487 angioplasties carried out in Canada each year may prevent 395 myocardial infarcts and 186 revascularization procedures, at an overall cos t of approximately $29 million and a cost effectiveness of approximately $5 0,000 per adverse event (This assumes the same proportional reduction in ev ents as in these four studies, and that 35% of procedures are high risk). SIGNIFICANCE: Possible eventual prolongation of life due to fewer periproce dural MIs with abciximab use cannot be quantified. Thus, these estimates of cost effectiveness cannot be used to compare this intervention directly wi th others in terms of dollars per life year saved. The field is evolving ra pidly and these conclusions may soon have to be modified. Increasing use of stents will probably slightly reduce, but not abolish, the health benefits of abciximab use. These estimates are based on only four trials. How ever, until more trials are completed they provide the best available evidence o n which to base policy decisions.