Abciximab - A pharmacoeconomic review of its use in percutaneous coronary revascularisation

Abciximab is a monoclonal antibody fragment that inhibits platelet aggregat ion through antagonism of glycoprotein IIb/IIIa, The drug is used in conjun ction with heparin and aspirin to prevent ischaemic complications associate d with percutaneous coronary revascularisation in patients with coronary he art disease, Large and well designed clinical studies have shown abciximab, as an adjunc t to aspirin and heparin, to reduce by around one-third to one-half the inc idence of ischaemic complications within 30 days of percutaneous coronary r evascularisation. Use of the drug appears advantageous in patients at high risk, and abciximab also reduces complications in patients undergoing coron ary stenting, although the drug does not appear to inhibit restenotic tissu e volume within stents, Longer term benefit has also been reported, with em erging 1-year data from a study in patients at all levels of risk showing r eductions in a composite end-point of death, myocardial infarction (MI) or urgent repeat revascularisation. Three-year benefit has been reported in hi gh risk patients, Meta-analysis results, and 1-year data from patients rece iving stents, have shown reduced mortality with abciximab. Abciximab therapy had an incremental cost over standard therapy from a hosp ital perspective of $US293 per patient (1991/1992 values) over 6 months in a prospective economic substudy from a major US clinical trial of the drug in high risk patients. Abciximab was cost saving in patients with unstable angina. A mean net cost of hospitalisation of $US476 per patients (1995 cos ts) has been shown in a further study in patients with a broad range of lev els of risk, and observational data indicate reduced duration of hospitalis ation with abciximab, Cost-effectiveness data favoured abciximab with aspirin and heparin over a 6-month period in Spanish and Dutch analyses in which data from the above t rial were combined with local cost data, but not in an Australian analysis. Subgroup analyses have indicated enhanced cost effectiveness in high risk patients. Available data also show clinical benefit and cost effectiveness of abciximab therapy in conjunction with coronary stent placement, Conclusions: Data indicate intravenous bolus plus 12-hour infusion regimens of abciximab to be economically viable in patients at high or low risk of ischaemic complications after percutaneous coronary revascularisation. The drug has been shown to be cost effective in patients receiving the drug in conjunction with coronary stents, and subgroup analyses indicate additional cost effectiveness in certain groups of patients at high risk of ischaemic complications (notably those with acute MI and unstable angina).