Authors' objectives:

Using a systematic review of economic evaluations and a primary economic evaluation, we examined the cost-effectiveness of the glycoprotein (GP) IIb/IIIa inhibitors abciximab and eptifibatide as adjuncts to elective and urgent PCI with stenting relative to routine percutaneous coronary intervention (PCI) and usual care (with stenting but without the additional drug therapy), from a provincial health insurance payer perspective.

Authors' results and conclusions: In the overall population, relative to stenting alone, stenting plus eptifibatide were dominant in the short term in terms of costs (reduced on average by $59 per procedure), rates of major adverse cardiac events (MACE) (reduced by 5.6%) and mortality (reduced by 1%). The same trend was found for those with diabetes. Costs were reduced on average b $166, MACE was reduced by 7.1% and mortality was reduced by 2%. In the long-term analysi for the overall population, the use of eptifibatide resulted in lower costs ($59) and increased life-years (0.22 undiscounted years per patient and 0.12 discounted years). For stenting plus abciximab, costs were higher (on average $1,171 per procedure) and clinical outcomes were better (MACE reduced by 7% and mortality by 1%) relative to stenting alone. Using an incremental cost-effectiveness analysis, we found that abciximab use falls in the range of what is generally considered to be cost-effective (approximately $17,000 per life-year gained for abciximab in the stented patient population). The results of the economic evaluation were robust to the probabilistic sensitivity analysis. For a value of a life-year of $50,000, the probability that abciximab is more cost-effective than usual care for all patients is 98.6%. For eptifibatide, it is 92.5%.

Authors' recommendations: The review of economic evidence supported the need for an up-to-date economic evaluation of GP IIb/IIIa inhibitors in a Canadian context. The economic evaluation in this study suggests that eptifibatide and abciximab can be considered to be cost-effective adjuncts for the control of complications in patients undergoing elective and urgent PCI. The incremental cost-effectiveness analysis for abciximab in the general study population showed a higher overal cost and better outcomes, with a result that is consistent with what is generally considered to be cost-effective. For eptifibatide in the general study population and for both drugs in those with diabetes, the analysis showed lower costs and better outcomes when compared with usual care We caution against a direct comparison of eptifibatide and abciximab based on the available data.

Authors' methods: Economic evaluation

Project Status: Completed

URL for project: https://www.ccohta.ca/publications/pdf/203_glycoproteins_tr_e.pdf

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)