Low dose heparin combined with abciximab reduces ischemic complications and associated costsEconomic assessment of platelet glycoprotein IIb/IIIa receptor blockade with abciximab and low-dose heparin during percutaneous coronary revascularization: results from the EPILOG randomized trial.
- Cannon, Christopher MD
- Lincoff, AM
- Mark, DB
- Tcheng, JE
- Califf, RM
- Bala, MV
- Anderson, KM
- Davidson-Ray, L
- Knight, JD
- Cabot, CF
- Topol, EJ
BACKGROUND
Platelet glycoprotein IIb/IIIa receptor blockade with abciximab reduces percutaneous coronary revascularisation complications. However, the drug is expensive and may be associated with increased bleeding. Lowering conjunctive weight adjusted heparin doses reduces ischemic complications and may also impact on cost-effectiveness.
OBJECTIVE
To compare the cost-effectiveness of abciximab with different doses of weight adjusted heparin.
SETTING
Sixty-nine US and Canadian centres; enrolment February-December 1995.
METHOD
Prospective economic assessment of randomised controlled trial.
LITERATURE REVIEW
No explicit strategy; 12 references.
PARTICIPANTS
2792 people undergoing percutaneous coronary revascularisation; average age 60 years; 72% male.
INTERVENTION
During revascularisation, participants were given placebo with standard weight adjusted heparin; abciximab with low dose weight adjusted heparin; or abciximab with standard weight adjusted heparin dose.
OUTCOMES
Medical costs and resource consumption.
ASSUMPTIONS
Medicare Fee Schedule was used to estimate physician fees and specific cost-to-charge ratios were calculated from hospital Medicare Cost Reports. Hospital billing information was estimated for 7% of the participants using multiple regression. Drug costs assumed a fixed price per vial with some wastage. All analyses were on an intention-to-treat basis and costs are in US dollars; year unspecified. Only hospitalisation and drug costs are considered, not productivity or outpatient costs.
MAIN RESULTS
There was no difference in initial hospitalisation and physician fee costs for the placebo and standard dose heparin groups (US$9632 versus $9092 per person; P = 0.18). But low dose heparin was associated with lower initial hospitalisation costs ($8758; P = 0.005). When drug costs were included in the analysis the low dose group cost an average of $583 more than the control group. The standard dose group cost an additional $914 per person. There were no significant differences in average hospital costs during a 6 month follow-up.
AUTHORS' CONCLUSIONS
Although abciximab is an expensive drug, combining it with low dose heparin enhances its cost-effectiveness by decreasing bleeding complications and hospital stays.