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.