A comparison of total hospital costs for percutaneous coronary intervention patients receiving abciximab versus tirofiban

The purpose of this study was to examine the total hospital costs associate d with the receipt of abciximab versus tirofiban for percutaneous coronary intervention (PCI) patients. Hospital billing data for patients with a prim ary procedure of PCI was examined for the period of July 1998 to June 1999 from HCIA-Sach's Clinical Pathways Database. Data were analyzed for all pat ient discharges whose records indicated use of abciximab or tirofiban with a PCI. Results are reported for 3,967 patients. Multivariate analysis was u sed to control for a wide range of factors (GP IIb/IIIa selection, patient demographics, stent use, insurance type, health conditions, admission infor mation, and hospital characteristics) that may influence the cost of hospit alization. A two-stage sample selection model was used to estimate total co sts. The first stage of the analysis utilizes a probit regression to determ ine the factors associated with the likelihood of receiving abciximab versu s tirofiban. The second stage of the analysis examines the factors associat ed with total hospital costs, while controlling for unobserved factors that may be correlated with the patient's likelihood of receiving abciximab. Th e mean unadjusted cost per hospitalization, including drug costs, was $10,7 62 (abciximab $10,813 and tirofiban $10,567). After controlling for high-ri sk indications and selection bias with the two-stage sample selection model , results indicate there was no significant difference in costs associated with the receipt of abciximab versus tirofiban. However, the results also i ndicate that the two-stage sample selection model may not be needed (X was not statistically significant) hence, the cost equation was reestimated usi ng ordinary least-squares methodology (OLS). In the OLS analysis, receipt o f abciximab versus tirofiban was associated with a significant reduction in costs ($470 reduction; P = 0.05). This study uses realworld data to examin e the total hospital costs for PCI patients who receive abciximab versus ti rofiban. Results of the two-stage sample selection model indicate there is no difference in total hospital costs (including drug costs) between abcixi mab- and tirofiban-treated patients. If the results of the OLS model are co nsidered, a slight decrease in total hospital costs is observed in abcixima b recipients. Cost-containment strategies that focus on component costs may not lead to intended overall cost savings. (C) 2001 Wiley-Liss, Inc.