ABCIXIMAB THERAPY IN PERCUTANEOUS INTERVENTION - ECONOMIC-ISSUES IN THE UNITED-STATES

Whether abciximab therapy should be the standard of care during percut aneous intervention in the United States depends on its efficacy, safe ty, and economics. In view of the EPIC, CAPTURE, and EPILOG data, few question the superior efficacy and relative safety of abciximab compar ed with conventional high-dose heparin therapy during percutaneous int ervention. Economic considerations have been the major issue limiting its use. Review of the economic data demonstrates that the incremental direct medical care cost of abciximab therapy is $290 to $600 per pat ient treated in the EPIC and EPILOG populations. In the patients with acute myocardial infarction and unstable angina, abciximab appears to reduce direct medical costs (pro duce cost savings) at 6 months. Given abciximab's significant incremental effectiveness, its relatively sma ll incremental cost yielded a highly cost-effective therapy in the EPI C and EPILOG patient populations. Additional economic issues relate to minimizing bleeding complications, indirect costs, reduced frequency of emergency procedures, and rationalizing provider/payor policies and incentives to produce the optimal individual patient and societal out comes. The currently available data concerning the efficacy, safety, a nd cost provide a compelling argument for embracing abciximab therapy in the treatment of patient subsets where it will be a cost-saving or cost-neutral adjunct to percutaneous coronary intervention. In other s ubsets, the direct medical cost will likely not be fully recouped, but the incremental cost-effectiveness will compare favorably to other wi dely accepted therapies.