Economic assessment of platelet glycoprotein IIb/IIIa receptor blockade with abciximab and low-dose heparin during percutaneous coronary revascularization - Results from the EPILOG randomized trial

Background-In the EPILOG trial (Evaluation in PTCA to Improve Long-term Out come with abciximab GP IIb/IIIa blockade), abciximab administered with weig ht-adjusted heparin diminished the risk of ischemic complications within 30 days by 56% among patients undergoing percutaneous coronary revascularizat ion, without increased bleeding complications. Methods and Results-A prospective economic assessment was performed in the 2792 patients enrolled in EPILOG. Patients were randomized to receive place bo with standard-dose weight-adjusted heparin, abciximab with low-dose weig ht-adjusted heparin, or abciximab with standard-dose weight-adjusted hepari n during percutaneous coronary intervention. Hospital billing data for the baseline hospitalization were collected for 2581 patients (92.4% of total) and imputed for the remainder, with physician fees estimated from the Medic are Fee Schedule. For the baseline hospitalization, medical costs (hospital ization and physician fees) averaged $9632 for the placebo arm compared wit h $8758 (P=0.005) and $9092 (P=0.176) for the abciximab with low-dose and s tandard-dose heparin arms, respectively. Inclusive of average drug cost ($1 454 to $1457), the net incremental baseline cost of these 2 abciximab strat egies was $583 with low-dose weight-adjusted heparin and $914 with standard -dose weight-adjusted heparin. During 6-month follow-up, average hospital c osts were not significantly different in the 3 treatment groups; cumulative net incremental costs were $1236 and $1268 in the abciximab with low-dose and standard-dose heparin groups, respectively. Conclusions-Treatment with abciximab and low-dose, weight-adjusted heparin during percutaneous coronary revascularization reduces ischemic events and associated costs, thereby offsetting some of the cost of the drug. The supp ression of bleeding complications associated with this agent by heparin dos e reduction optimizes the economic attractiveness of this treatment strateg y.