Economic assessment of tirofiban in the management of acute coronary syndromes in the hospital setting - An analysis based on the PRISM PLUS trial

Aims We analysed whether generalized use of tirofiban plus heparin and aspi rin might save direct healthcare costs, as compared with heparin and aspiri n alone, in patients with acute coronary ischaemic syndromes in Switzerland . Methods and Results We conducted an incremental cost-consequence analysis f rom the perspective of the admitting hospital for the period of the first 7 days. Costs were analysed for the management of refractory ischaemic condi tions and myocardial infarctions, including incremental days on the general ward or intensive care unit, as well as necessary revascularization proced ures, and expressed in Swiss francs (CHF) and European currency units (ECU) . Drug costs were based on a loading dose of 0.4 mu.kg(-1).min(-1) and a ma intenance dose of 0.1 mu.kg(-1).min(-1) for tirofiban at a cost of CHF 273. 55 (ECU 166.50) per vial. Heparin was administered at a loading dose of 500 0U and a maintenance dose of 1000 U.h(-1). All calculations were standardiz ed to 100 treated patients. The costs of managing ischaemic complications w ere based on typical practice patterns in Swiss hospitals. The incremental costs per patient of managing unstable angina patients with recurrent ischa emia or myocardial infarction were calculated as CHF 23 325 (ECU 14 198) an d CHF 18 599 (ECU 11 321), respectively. The incremental drug costs amounte d to CHF 82 065 (ECU 49 954). The additional use of tirofiban resulted in n et savings of CHF 54 899 (ECU 33 418) per 100 patients, achieved through a reduction in the cost of treating refractory ischaemic conditions (CHF 79 3 06, ECU 48 275) and myocardial infarctions (CHF 57 658, ECU 35 097). Conclusion Tirofiban is cost-saving in acute coronary ischaemic syndromes a nd improves the economics of managing these patients during the initial hos pitalization.