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European Heart Journal 2001 22(16):1476-1484; doi:10.1053/euhj.2000.2543
Copyright © 2001 by the European Society of Cardiology.
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Cost-efficacy in interventional cardiology; results from the EPISTENT study

J.E.F Zwart-van Rijkoma,b,f1 and B.A van Houtc

a Erasmus University, Institute for Medical Technology Assessment, Rotterdam, The Netherlands
b Utrecht University, Department of Pharmaco-epidemiology and Pharmacotherapy, Utrecht, The Netherlands
c University Medical Center Utrecht, Julius Center for General Practice and Patient-oriented Research, Utrecht, The Netherlands

revised November 13, 2000; accepted November 22, 2000

Abstract

Aims The EPISTENT study has demonstrated that the combined use of abciximab and stenting as an adjunct to PTCA leads to increased event-free survival compared to either using abciximab or stenting alone. However, this combined strategy may be costly and the additional costs have to be weighted against the additional effects.

Method and Results The 6-months efficacy data from the EPISTENT study are combined with Dutch estimates of unit costs. Adding a stent to a procedure with abciximab further decreases the number of revascularizations at an extra cost of Euros12000 (95% upper limit (u.l.) Euros31000) per additional major adverse cardiac event-free survivor. Adding abciximab to a stenting procedure decreases the incidence of myocardial infarctions at an extra cost of Euros13000 (95% u.l. Euros27000) per additional myocardial infarction-free survivor. In the subgroup of diabetics, adding abciximab improves revascularization rates as well, resulting in a cost-efficacy rate of Euros2000 (95% u.l. Euros25000) per additional MACE-free survivor, with uncertainty regions indicating potential costs savings.

Conclusion The combination of stenting and abciximab costs about Euros13000 to avoid one event after PTCA. In diabetic patients the strategy may be cost-saving.

Key Words: Cost-effectiveness, platelet aggregation inhibitors, stents, clinical trials, diabetes mellitus

f1 Correspondence: Jeannette E. F. Zwart-van Rijkom, Department of Pharmaco-epidemiology and Pharmacotherapy, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands.

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