PMID- 16637790
OWN - NLM
STAT- MEDLINE
DCOM- 20060920
LR  - 20181201
IS  - 0277-0008 (Print)
IS  - 0277-0008 (Linking)
VI  - 26
IP  - 5
DP  - 2006 May
TI  - Cost-effectiveness analysis of antithrombotic therapy in nonurgent percutaneous 
      coronary intervention.
PG  - 609-18
AB  - STUDY OBJECTIVE: To perform a cost-effectiveness analysis comparing three 
      treatment approaches during nonurgent percutaneous coronary intervention (PCI): 
      bivalirudin with provisional glycoprotein (GP) IIb-IIIa inhibitor therapy, 
      unfractionated heparin (UFH) with eptifibatide, and UFH with abciximab. DESIGN: 
      Literature-based decision model from an institutional perspective. DATA SOURCE: 
      Patient data from the Randomized Evaluation in PCI Linking Angiomax to Reduced 
      Clinical Events (REPLACE)-2 study and three other randomized controlled trials 
      that included UFH and routine GP IIb-IIIa inhibitor (eptifibatide or abciximab) 
      therapy. All included studies were comparable based on patient population, 
      procedural techniques, and general treatment approaches. MEASUREMENTS AND MAIN 
      RESULTS: We included patient populations undergoing contemporary nonurgent PCI to 
      identify probabilities of success or complications (myocardial infarction, urgent 
      revascularization, thrombocytopenia, and major or minor bleeding at 30 days). 
      Costs were assigned to each outcome by incorporating diagnosis-related group-- 
      and/or Current Procedural Terminology--associated costs, institutional drug 
      acquisition costs, and unit replacement costs of platelets and red blood cells. 
      In the base-case analysis, the use of bivalirudin with provisional GP IIb-IIIa 
      inhibitor therapy dominated the UFH and planned GP IIb-IIIa inhibitor approach: 
      UFH with eptifibatide was 74 US dollars more expensive and 1.2% less effective, 
      and UFH with abciximab was 777 US dollars more expensive and 2.3% less effective. 
      Sensitivity analyses indicated that the model results were robust, but also 
      revealed that bivalirudin lost its cost-effectiveness, resulting in UFH with 
      eptifibatide becoming more cost-effective, when two or more vials of bivalirudin 
      were necessary in greater than 27% of cases or when the use of provisional GP 
      IIb-IIIa inhibitor therapy exceeded 20%. CONCLUSION: This analysis indicates that 
      bivalirudin with provisional GP IIb-IIIa inhibitor therapy is the most 
      cost-effective antithrombotic treatment strategy in nonurgent PCI when its use 
      and dosing are consistent with the REPLACE-2 trial.
FAU - Summers, Kelly M
AU  - Summers KM
AD  - School of Pharmacy, University of Maryland, Baltimore, USA.
FAU - Holdford, David A
AU  - Holdford DA
FAU - Crouch, Michael A
AU  - Crouch MA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Immunoglobulin Fab Fragments)
RN  - 0 (Peptide Fragments)
RN  - 0 (Peptides)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - NA8320J834 (Eptifibatide)
RN  - TN9BEX005G (bivalirudin)
RN  - X85G7936GV (Abciximab)
SB  - IM
MH  - Abciximab
MH  - *Angioplasty, Balloon, Coronary
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Antithrombins/economics/therapeutic use
MH  - Coronary Disease/*drug therapy/epidemiology
MH  - Cost-Benefit Analysis
MH  - Databases, Factual
MH  - Decision Support Techniques
MH  - Drug Costs
MH  - Eptifibatide
MH  - Fibrinolytic Agents/administration & dosage/*economics/*therapeutic use
MH  - Heparin/economics/therapeutic use
MH  - Hirudins/economics
MH  - Humans
MH  - Immunoglobulin Fab Fragments/therapeutic use
MH  - Peptide Fragments/economics/therapeutic use
MH  - Peptides/economics/therapeutic use
MH  - Platelet Aggregation Inhibitors/economics/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Postoperative Complications/*economics/*prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/economics/therapeutic use
MH  - Treatment Outcome
EDAT- 2006/04/28 09:00
MHDA- 2006/09/21 09:00
CRDT- 2006/04/28 09:00
PHST- 2006/04/28 09:00 [pubmed]
PHST- 2006/09/21 09:00 [medline]
PHST- 2006/04/28 09:00 [entrez]
AID - 10.1592/phco.26.5.609 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2006 May;26(5):609-18. doi: 10.1592/phco.26.5.609.