Jef. Zwart-van Rijkom et Ba. Van Hout, Cost-efficacy in interventional cardiology - Results from the EPISTENT study, EUR HEART J, 22(16), 2001, pp. 1476-1484
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.