Abciximab: Cost-effective survival advantage in clinical trials and clinical practice

Adjunctive blockade of the platelet glycoprotein (GP) IIb/IIIa receptor dur ing either percutaneous coronary intervention (PCI) or for patients who pre sent with non-ST segment elevation acute coronary syndromes has demonstrate d efficacy in reducing platelet-mediated adverse cardiovascular ischemic ev ents. The three currently available agents (abciximab, eptifibatide, tirofi ban) differ markedly in pharmacodynamic and pharmacokinetic profiles, recep tor affinity, and cost. Although pharmacoeconomic substudies are available from placebo-controlled randomized trials of platelet GPIIb/IIIa blockade d uring PCI, "real-world" cost-effectiveness data from high-volume practice a re lacking. Therefore, in-hospital and late (6-month) clinical:outcomes and cumulative cost/charge data were analyzed on 1472 consecutive PCI procedur es (70% received abciximab) performed by high-volume operators at a single institution.(1) Data were adjusted for lack of randomized treatment allocat ion with the use of a propensity scoring technique. Adjunctive abciximab th erapy for PCI was associated with a significant (3.4%) reduction in mortali ty to 6 months. Based on the economic cost-effectiveness concept of cost pe r life year gained relative to standard therapy,(2,3) abciximab provided a cost-effective survival advantage in high-volume interventional practice th at compares very favorably with currently accepted standards. Clinical and procedural demographics associated with; increased cost-effectiveness inclu de multivessel coronary intervention, stent deployment, recent (<1 week) my ocardial infarction (MI), and impaired left-ventricular (IV) function.