PCV34: DECISION ANALYSIS MODEL OF ABCIXIMAB, EPTIFIBATIDE OR STANDARD THERAPY IN ELECTIVE STENT PLACEMENT: A CANADIAN PERSPECTIVE

Abstract

The use of glycoprotein 2b/3a receptor antagonists has been shown to be beneficial in elective coronary stent implantation. In Canada, the cost of abciximab has limited widespread use in this population. Recently presented data comparing eptifibatide with heparin alone in a similar population has suggested a significant improvement in clinical outcomes with this less expensive agent. There are no trials directly comparing these two agents in the elective stent patient population. OBJECTIVE: the purpose of this study was to assess the cost-effectiveness of abciximab or eptifibatide compared to standard therapy in patients undergoing elective stent placement in a Canadian setting using a decision analysis model. METHODS: Clinical outcome data was abstracted from the Epistent and Esprit trials. Economic data assessing direct costs for coronary intervention procedures and complications was acquired from the London Health Sciences Centre hospital cost database for the period 1998?99. The composite clinical endpoint was freedom from death, myocardial infarction and urgent revascularization at 30 days. The primary study outcome was the incremental cost per event prevented. RESULTS: In the baseline analysis, both agents compared favorably with standard therapy. Abciximab had an incremental cost-effectiveness of $US 10,320 per event prevented. Eptifibatide was less costly and more effective, hence dominant over standard therapy. The baseline analysis yielded a benefit of 6 events per 1,000 patients treated in favour of abciximab over eptifibatide. However the incremental cost per event prevented was $US 125,218, a less favorable value. CONCLUSION: The incremental cost-effectiveness of abciximab compared to eptifibatide was sensitive to the cost of abciximab and to the incidence of myocardial infarctions. A randomized trial comparing abciximab and eptifibatide in elective coronary stent placement is necessary to better assess this issue.