Cost effectiveness of abciximab during routine medical practice

Objective: To estimate the cost per ischaemic event (death, nonfatal myocar dial infarction, subsequent revascularisation procedure) avoided at 6 month s in high risk patients undergoing coronary revascularisation treated with abciximab during routine medical care. Design: Retrospective, matched cohort design. Setting: University teaching hospital. Patients: 62 abciximab-treated patients and 62 patients not treated with ab ciximab with high risk coronary lesions were matched according to gender, h yperlipidaemia, diabetes mellitus and stenting. Main Outcome Measures: Using a third-party payer's perspective, an incremen tal cost-effectiveness ratio (ICER) was computed as the cost per ischaemic event avoided over 6 months. Fieller's theorem was used to estimate confide nce sets and confidence ellipses were generated to visually represent the v ariability in the data. Results: At 6 months, abciximab-treated patients experienced an approximate ly 40% lower rate of ischaemic events (16.1 vs 27.4%; p = 0.128). The point estimate of the ICER was $US21 789 per ischaemic event avoided. Fieller's theorem resulted in a 95% confidence set consisting of 2 half-lines (-infin ity to -$US115 461) and ($US391 to +infinity), reflecting the finding that the ICER denominator was not significantly different from zero at the p = 0 .05 level. Conclusions: In high risk patients treated during routine care, the effecti veness of abciximab was consistent with efficacy rates from clinical trials . However, abciximab-treated patients remained approximately $US2400 more c ostly at 6 months.