Abciximab provides cost-effective survival advantage in high-volume interventional practice

Background Placebo-controlled randomized trials of platelet glycoprotein (G P) IIb/IIIa blockade during percutaneous coronary intervention have demonst rated efficacy of these agents for reducing the risk of periprocedural isch emic events. However, cost-effectiveness of this adjunctive pharmacotherapy has been scrutinized. Extrapolation of cost-efficacy observations from cli nical trials to "real world" interventional practice is problematic. Methods consecutive percutaneous coronary interventions (n = 1472) performe d by Ohio Heart Health Center operators at The Christ Hospital, Cincinnati, Ohio, in 1997 were analyzed for procedural and long-term (6-month) outcome s and charges. Observations on cost and efficacy (survival) were adjusted f or nonrandomized abciximab allocation by means of "propensity scoring" meth ods. Results Abciximab therapy was associated with a survival advantage to 6 mon ths after percutaneous coronary intervention. The average reduction in mort ality rate at b months was 3.4% (unadjusted) and 4.9% when adjusted for non randomization. The average charge increment to 6 months was $1512 (unadjust ed) and $950 when adjusted for nonrandomization. Patients deriving the grea test reduction in mortality rates also had a reduction in total cardiovascu lar charges to b months. Distinguishing demographics of this population inc luded multivessel coronary intervention, coronary stent deploy ment, interv ention within 1 week of myocardial infarction, and lower left ventricular e lection fraction. The average cost per lire-year gained in this study was $ 2875 for all patients (unadjusted) and $1243 when adjusted for nonrandomiza tion. Conclusions Abciximab provides a cost-effective survivor advantage in high- volume interventional practice that compares favorably with currently accep ted standards. Clinical and procedural demographics associated with increas ed cost-effectiveness included multivessel coronary intervention, stent dep loyment, recent (<1 week) myocardial infarction, and impaired left ventricu lar function.