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Cost-efficacy in interventional cardiology; results from the EPISTENT study

J.E.F Zwart-van Rijkom, B.A van Hout
DOI: http://dx.doi.org/10.1053/euhj.2000.2543 1476-1484 First published online: 2 August 2001


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.

  • Cost-effectiveness, platelet aggregation inhibitors, stents, clinical trials, diabetes mellitus