Heart 1998;79:12-17 ( January )
Effectiveness and cost-effectiveness of single bolus treatment with abciximab (Reo Pro) in preventing restenosis following percutaneous transluminal coronary angioplasty in high risk patients
a Medical Technology Assessment Group, Sydney,
Australia, b Health Economics and Outcomes Research, Research and
Development, Eli-Lilly, Sydney, Australia
Correspondence to: Mike Aristides, Director, M-TAG, PO Box 5639, Chatswood, NSW 2057, Australia.
Accepted for publication 27 June 1997
Objective
To assess the clinical
effectiveness and cost effectiveness of abciximab in preventing
restenosis after percutaneous transluminal coronary angioplasty (PTCA).
DesignData from a previous study, the EPIC trial,
were used because only this trial was able to provide event data
capable of constructing a cost effectiveness analysis over six months.
All other study data reviewed supported the findings of the EPIC trial.
To provide indicative results on long term health outcomes, survival
and event-free survival were extrapolated using US epidemiological data
in a Markov modelling process.
Setting and patientsPatients who were at high
risk for ischaemic complications after PTCA, treated in the
standard manner.
InterventionsAbciximab was added to the
regimen of intravenous heparin and aspirin.
ResultsThe EPIC study (n = 2099) indicated an
8.1% absolute reduction in serious cardiovascular events (95%
confidence interval 3.1% to 12.7%) and a 23% relative risk reduction
(p = 0.001). Based on the six month trial period, the additional cost
per patient free from a serious event (Australian dollars) is $13 012
and for a special risk/benefit measure of outcome, the additional cost
is $14 243. Epidemiological data support extended survival and
ischaemic event-free survival with clinically successful PTCA. The
results of the modelled analysis indicate a cost per additional life-year gained of $5547 and a cost per additional year event-free of
$4285.
ConclusionsAt up to six months abciximab
offers improvements in clinically important outcomes. A modelling
exercise explores and highlights the likelihood of significant long
term health benefits. The analysis provides information for decision
makers and funders to consider the value for money of abciximab.
© 1998 by Heart
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Wharton, T. P. Jr., Sinclair McNamara, N., Fedele, F. A., Jacobs, M. I., Gladstone, A. R., Funk, E. J.
(2000). Reply. J Am Coll Cardiol
36: 301-303
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