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| Publications [#197907] of Daniel B. Mark
Papers Published
- DB Mark, RA Harrington, AM Lincoff, RM Califf, CL Nelson, AA Tsiatis, H Buell, KW Mahaffey, L Davidson-Ray, EJ Topol, Cost-effectiveness of platelet glycoprotein IIb/IIIa inhibition with eptifibatide in patients with non-ST-elevation acute coronary syndromes.,
Circulation, vol. 101 no. 4
(February, 2000),
pp. 366-71, ISSN 1524-4539
(last updated on 2011/11/29)
Abstract:
BACKGROUND: In the PURSUIT trial, eptifibatide significantly reduced the 30-day incidence of death and myocardial infarction relative to placebo in 9461 patients with an acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction). RESULTS: We conducted a 2-part prospective economic substudy of the 3522 US patients enrolled in PURSUIT: (1) an empirical intention-to-treat comparison of medical costs (hospital plus physician) up to 6 months after hospitalization and (2) a lifetime cost-effectiveness analysis. The base-case cost-effectiveness ratio was expressed as the 1996 US dollars required to add 1 life-year with eptifibatide therapy. The 2 treatment arms had equivalent resource consumption and medical costs (exclusive of the cost of the eptifibatide regimen) during the index (enrollment) hospitalization (P=0.78) and up to 6 months afterward (P=0.60). The average wholesale price of the eptifibatide regimen was $1217, but a typical hospital discounted price was $1014. The estimated life expectancy from randomization in the US patients was 15.96 years for eptifibatide and 15.85 years for placebo, an incremental difference of 0.111. The incremental cost-effectiveness ratio for eptifibatide therapy in US PURSUIT patients was $16 491 per year of life saved. This result was robust through a wide range of sensitivity analyses. The cost-utility ratio for eptifibatide (using time trade-off defined utilities) was $19 693 per added quality-adjusted life-year. CONCLUSIONS: Based on the results observed in the US PURSUIT patients, the routine addition of eptifibatide to standard care for non-ST-elevation acute coronary syndrome patients is economically attractive by conventional standards.
Keywords:
Angina, Unstable • Cost-Benefit Analysis • Female • Follow-Up Studies • Humans • Length of Stay • Male • Middle Aged • Myocardial Infarction • Peptides • Platelet Aggregation Inhibitors • Platelet Glycoprotein GPIIb-IIIa Complex • Prospective Studies • Risk Factors • United States • antagonists & inhibitors • drug therapy* • economics • therapeutic use*
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