Cost-efficacy in interventional cardiology - Results from the EPISTENT study

Aims The EPISTENT study has demonstrated that the combined use of abciximab and stenting as an adjunct to PTCA leads to increased event-free survival compared to either using abciximab or stenting alone. However, this combine d strategy may be costly and the additional costs have to be weighted again st the additional effects. Method and Results The 6-months efficacy data from the EPISTENT study are c ombined with Dutch estimates of unit costs. Adding a stent to a procedure w ith abciximab further decreases the number of revascularizations at an extr a cost of Euros 12 000 (95% upper limit (u.l.) Euros 31 000) per additional major adverse cardiac event-free survivor. Adding abciximab to a stenting procedure decreases the incidence of myocardial infarctions at an extra cos t of Euros 13 000 (95% u.l. Euros 27 000) per additional myocardial infarct ion-free survivor. In the subgroup of diabetics, adding abciximab improves revascularization rates as well, resulting in a cost-efficacy rate of Euros 2000 (95% u.l. Euros 25 000) per additional MACE-free survivor, with uncer tainty regions indicating potential costs savings. Conclusion The combination of stenting and abciximab costs about Euros 13 0 00 to avoid one event after PTCA. In diabetic patients the strategy may be cost-saving.