COST-EFFECTIVENESS ANALYSIS OF ABCIXIMAB - A CANADIAN HOSPITAL PERSPECTIVE

OBJECTIVE: To assess the cost-effectiveness of abciximab therapy versu s traditional practice in high-risk patients receiving percutaneous tr ansluminal coronary angioplasty (PTCA) from a Canadian hospital perspe ctive. DESIGN: A predictive decision analytic model using published cl inical and economic evaluations, as well as costs of medical care in C anada. SUBJECTS: High-risk PTCA patients as defined by the Evaluation of c7E3 for Prevention of Ischemic Complications trial and the c7E3 Fa b Antiplatelet Therapy in Unstable Refractory Angina trial. INTERVENTI ONS: TWO treatment strategies were compared: (1) abciximab 0.25 mg/kg intravenous bolus 10 minutes prior to PTCA followed by abciximab 10 mu g/min intravenous infusion for 12 hours after the procedure, and (2) no abciximab adjunctive therapy at the time of PTCA. Both treatment st rategies were combined with: intravenous heparin up to 100 units/kg bo lus pre-PTCA followed by bolus doses for 1 hour after PTCA per the pro tocol. Cumulative outcomes were considered up to 6 months after initia l PTCA. RESULTS: At 6 months, 29% of the patients in the abciximab tre atment arm compared with 33% in the no abciximab arm achieved one of t he primary events; The most common adverse event experienced was major bleeding at 4% in the abciximab treatment arm versus 1.6% in the no a bciximab arm. The average cost per patient for each strategy was $3261 Can ($1 Can = $0.686 US) (abciximab arm) versus $2073 Can(no abcixima b arm), resulting in an incremental cost-effectiveness ratio of $29 70 0 Can per event-free patient. In univariate sensitivity analyses, the only controllable factor that changed the results of the cost-effectiv eness outcome was the cost of abciximab. CONCLUSIONS: Although the use of abciximab as an adjunct to PTCA results in a reduction in event ra tes in high-risk patients compared with traditional treatment, there i s an increased cost associated with this strategy.