PMID- 18489507
OWN - NLM
STAT- MEDLINE
DCOM- 20090715
LR  - 20220330
IS  - 1524-4733 (Electronic)
IS  - 1098-3015 (Linking)
VI  - 11
IP  - 5
DP  - 2008 Sep-Oct
TI  - Using triple antiplatelet therapy in patients with non-ST elevation acute 
      coronary syndrome managed invasively: a cost-effectiveness analysis.
PG  - 853-61
LID - 10.1111/j.1524-4733.2008.00338.x [doi]
AB  - OBJECTIVES: To assess the incremental cost-effectiveness ratio (ICER) of 
      glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors in patients with non-ST elevation 
      acute coronary syndrome (NSTE-ACS) pretreated with aspirin and clopidogrel 
      undergoing an early invasive treatment strategy. METHODS: Cost-effectiveness 
      analysis and cost-utility analysis were performed from a health-care system 
      perspective, based on a Markov model with a time horizon of the patient life 
      span. The risk of death and ischemic events was assessed using the Thrombolysis 
      in Myocardial Infarction (TIMI) risk score. We compared three strategies: 1) 
      routine upstream use of a GPIIb/IIIa inhibitor to all patients before 
      angiography, 2) deferred selective use of abciximab in the catheterization 
      laboratory just before angioplasty, and 3) double antiplatelet therapy without 
      GPIIb/IIIa inhibitors. Both univariate sensitivity analysis and second-order 
      probabilistic microsimulation were performed. RESULTS: In the base case (65 years 
      old, TIMI score 3), strategy A was the most effective, with an ICER of 15,150 
      euros per quality-adjusted life-year gained. Strategy B was dominated by a 
      combination of strategies A and C. The ICER was very sensitive to the age and 
      baseline risk of the patient. According to the widely accepted cost-effectiveness 
      thresholds, strategy A would be cost-effective only in patients with an 
      intermediate to high TIMI score, especially within the younger age groups. The 
      probability that strategy A was cost-effective under the base case was 91.2%. 
      CONCLUSIONS: The use of GPIIb/IIIa inhibitors upstream in high-risk NSTE-ACS 
      patients (TIMI score > or = 3) pretreated with aspirin and clopidogrel is 
      cost-effective, particularly in the younger age groups.
FAU - Latour-Perez, Jaime
AU  - Latour-Perez J
AD  - Intensive Care Unit, Hospital General Universitario de Elche, Elche, Spain. 
      jlatour@wanadoo.es
FAU - de Miguel Balsa, Eva
AU  - de Miguel Balsa E
FAU - Betegon, Lourdes
AU  - Betegon L
FAU - Badia, Xavier
AU  - Badia X
LA  - eng
PT  - Journal Article
DEP - 20080516
PL  - United States
TA  - Value Health
JT  - Value in health : the journal of the International Society for Pharmacoeconomics 
      and Outcomes Research
JID - 100883818
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy/economics
MH  - Aged
MH  - Aspirin/*economics/therapeutic use
MH  - Clopidogrel
MH  - Confidence Intervals
MH  - Cost-Benefit Analysis
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Male
MH  - Markov Chains
MH  - Models, Economic
MH  - Platelet Aggregation Inhibitors/*economics/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Quality-Adjusted Life Years
MH  - Risk
MH  - Risk Assessment
MH  - Spain
MH  - Ticlopidine/*analogs & derivatives/economics/therapeutic use
EDAT- 2008/05/21 09:00
MHDA- 2009/07/16 09:00
CRDT- 2008/05/21 09:00
PHST- 2008/05/21 09:00 [pubmed]
PHST- 2009/07/16 09:00 [medline]
PHST- 2008/05/21 09:00 [entrez]
AID - S1098-3015(10)60564-5 [pii]
AID - 10.1111/j.1524-4733.2008.00338.x [doi]
PST - ppublish
SO  - Value Health. 2008 Sep-Oct;11(5):853-61. doi: 10.1111/j.1524-4733.2008.00338.x. 
      Epub 2008 May 16.