OBJECTIVES: Approximately 140,000 percutaneous coronary interventions (PCIs) will be performed in France in 2009/2010. PCI complications often increase resource utilization. New antithrombotic therapies have the potential to improve outcomes and decrease costs. The ACUITY trial demonstrated a decreased mortality and a statistically significant reduction in bleeding events with bivalirudin as compared to a heparin-plus-GPI (HEP+GPI) regimen. This analysis evaluated the economic impact of this improvement in the French hospital setting with a focus on reduced access site- and non-access site-related bleeding events. METHODS: A budget-impact model was developed to evaluate the impact of bivalirudin in high-risk (per ESC definition) UA/NSTEMI patients undergoing PCI in a French hospital. Clinical data for the model were derived from the ACUITY trial and included 30-day event rates for major complications (total and non-access site bleeding, Q-wave myocardial infarction, repeat PCI and coronary artery bypass graft). Economic data were derived from French medical literature, including clinical event costs, ward costs (both regular and ICU/ CCU) and pharmaceutical costs. RESULTS: In 100 PCI patients, bivalirudin use would result in 4 fewer protocol-defined major bleeding events (3.8%) and 12 fewer minor bleeding events (12.2%). Considering non-access site bleeding events only (all bleeds excluding retroperitoneal and access site bleeds), bivalirudin use would reduce major and minor bleeding events by 0.7% and 4.7%, respectively. Including all bleeding events, the total hospital budget impact of treating 100 high risk UA/NSTEMI patients using a HEP+GPI-based strategy is 3626,903. Introducing a bivalirudin-based strategy could save 332,520 (5%). The reduction in non-access site bleeding events alone could result in savings of 318,028 (3%) per 100 patients. CONCLUSIONS: A bivalirudinbased strategy for anticoagulant use in high risk UA/NSTEMI patients undergoing PCI is associated with favorable clinical and economic outcomes when compared with HEP+GPI in a French hospital setting.
Olchanski, N., Slawsky, K., Cyr, P., Schwenkglenks, M., & Steinhubl, S. (2010). PCV43 CLINICAL AND ECONOMIC IMPACT OF BIVALIRUDIN ON BLEEDING EVENTS IN HIGH RISK UNSTABLE ANGINA (UA)/NON-ST-ELEVATION MYOCARDIAL INFARCTION (NSTEMI) PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI) IN FRANCE. Value in Health, 13(3), A157. https://doi.org/10.1016/s1098-3015(10)72763-7