PT  - JOURNAL ARTICLE
AU  - Matthias Schwenkglenks
AU  - Toby J Toward
AU  - Stephanie Plent
AU  - Thomas D Szucs
AU  - Daniel J Blackman
AU  - Andreas Baumbach
TI  - Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of acute ST-segment elevation myocardial infarction
AID  - 10.1136/heartjnl-2011-301323
DP  - 2012 Apr 01
TA  - Heart
PG  - 544--551
VI  - 98
IP  - 7
4099  - http://heart.bmj.com/content/98/7/544.short
4100  - http://heart.bmj.com/content/98/7/544.full
SO  - Heart2012 Apr 01; 98
AB  - Objective To assess the cost-effectiveness of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitor (H-GPI) in patients undergoing primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI), from a UK health service perspective.Design Cost-utility analysis with life-long time horizon.Main outcome measures Costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness.Methods Event risks and medical resource use data derived from the HORIZONS-AMI trial were entered into a decision analytic model. Clinical events until the end of year 1 (main model) or year 3 (alternative model) were modelled in detail. Adjustments were applied to approximate UK routine practice characteristics. Life expectancy of 1-year or 3-year survivors, health-state utilities, initial hospitalisation length of stay in the comparator strategy and unit costs were based on UK sources. Costs and effects were discounted at 3.5%.Results The main model predicted bivalirudin and H-GPI patients to survive 11.52 and 11.35 (undiscounted) years on average, respectively, and to accrue 6.26 and 6.17 QALYs. Patient lifetime costs were £267 lower in the bivalirudin strategy (£12 843 vs £13 110). Extensive sensitivity and scenario analyses confirmed these results to be robust. In probabilistic analysis, quality-adjusted survival was higher and costs were lower with bivalirudin in 95.0% of simulation runs. In 99.2%, cost-effectiveness was better than £20 000 per QALY gained. Results from the alternative model were fully consistent.Conclusion The use of bivalirudin instead of H-GPI in STEMI patients undergoing PPCI is cost-effective, and offers a high probability of dominance. Background treatment with aspirin and clopidogrel is assumed.