PMID- 21068538
OWN - NLM
STAT- MEDLINE
DCOM- 20101230
LR  - 20161125
IS  - 2154-8331 (Print)
IS  - 2154-8331 (Linking)
VI  - 38
IP  - 4
DP  - 2010 Nov
TI  - Economic impact of switching to bivalirudin for a primary percutaneous coronary 
      intervention in a US hospital.
PG  - 138-46
LID - 10.3810/hp.2010.11.351 [doi]
AB  - BACKGROUND: The addition of glycoprotein IIb/IIIa inhibitors (GPIs) to heparin in 
      percutaneous coronary intervention (PCI) procedures has been demonstrated to 
      reduce ischemic complications; however, GPI use is known to increase the risk of 
      bleeding events, which are linked to increased mortality, longer hospital length 
      of stay, greater medical resource utilization, and increased costs. New 
      antithrombotic therapies have the potential to improve clinical outcomes and 
      decrease costs. The Harmonizing Outcomes with Revascularization and Stents in 
      Acute Myocardial Infarction (HORIZONS-AMI) study of bivalirudin demonstrated 
      significantly reduced clinical event rates (mortality and bleeding) compared with 
      an unfractionated heparin (UFH)+GPI regimen. OBJECTIVE: The potential clinical 
      and economic value of implementing a bivalirudin-based strategy for ST-segment 
      elevation myocardial infarction (STEMI) patients receiving primary PCI (PPCI) is 
      compared with current UFH+GPI-based practice from a US hospital perspective. 
      METHODS: A budget impact model was developed to compare treatment of STEMI 
      patients undergoing PPCI with a bivalirudin- or UFH+GPI-based strategy. Clinical 
      data for the model were derived from the HORIZONS-AMI trial, and included 30-day 
      event rates for major complications (eg, protocol bleeding, Q-wave MI, repeat 
      PCI, and coronary artery bypass graft procedures). United States cost data and 
      clinical practice data were derived from a Premier Perspective database analysis 
      and published sources. RESULTS: Overall, average procedure costs per 
      UFH+GPI-treated patient were $18,561. Treating patients with bivalirudin 
      (incorporating 7.2% provisional GPI use per HORIZONS-AMI) may save $1690 per 
      patient (average procedural cost, $16,872). In extrapolating these benefits to 
      the American College of Cardiology/American Heart Association recommended 
      institutional minimum of 36 PPCIs annually, 1 major bleeding event (3.7%) and 3 
      minor bleeding events (6.8%) could be averted with use of bivalirudin. In 
      addition, introducing a bivalirudin-based strategy to treat a minimum cohort of 
      36 STEMI patients would save the hospital budget $60,807 (9%) per year. 
      CONCLUSION: Using a bivalirudin-based strategy in STEMI patients undergoing PPCI 
      is associated with favorable clinical and economic outcomes when compared with an 
      UFH+GPI-based strategy in a US hospital setting.
FAU - Olchanski, Natalia
AU  - Olchanski N
AD  - Boston Healthcare Associates, Inc., Boston, MA 02110, USA. 
      nolchanski@bostonhealthcare.com
FAU - Slawsky, Katherine A
AU  - Slawsky KA
FAU - Plent, Stephanie
AU  - Plent S
FAU - Kado, Carla
AU  - Kado C
FAU - Cyr, Philip L
AU  - Cyr PL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Hosp Pract (1995)
JT  - Hospital practice (1995)
JID - 101268948
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - *Angioplasty, Balloon, Coronary
MH  - Antithrombins/adverse effects/*economics/therapeutic use
MH  - Boston/epidemiology
MH  - Budgets
MH  - Cost Savings
MH  - Drug Costs
MH  - Economics, Pharmaceutical
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin/economics/therapeutic use
MH  - Hirudins/adverse effects/*economics
MH  - Hospital Costs/*statistics & numerical data
MH  - Humans
MH  - *Models, Econometric
MH  - Myocardial Infarction/mortality/*therapy
MH  - Peptide Fragments/adverse effects/*economics/therapeutic use
MH  - Platelet Aggregation Inhibitors/economics/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Recombinant Proteins/adverse effects/economics/therapeutic use
MH  - Reoperation
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2010/11/12 06:00
MHDA- 2010/12/31 06:00
CRDT- 2010/11/12 06:00
PHST- 2010/11/12 06:00 [entrez]
PHST- 2010/11/12 06:00 [pubmed]
PHST- 2010/12/31 06:00 [medline]
AID - 10.3810/hp.2010.11.351 [doi]
PST - ppublish
SO  - Hosp Pract (1995). 2010 Nov;38(4):138-46. doi: 10.3810/hp.2010.11.351.