Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of non-ST-segment elevation acute coronary syndromes.

Abstract

OBJECTIVES:

This study sought to assess the cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor (GPI) in thienopyridine-treated non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients undergoing early or urgent invasive management, from a United Kingdom National Health Service perspective.

METHODS:

A decision-analytic model with lifelong time horizon was populated with event risks and resource use parameters derived from the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial raw data. In a parallel analysis, key comparator strategy inputs came from Global Registry of Acute Coronary Events (GRACE) patients enrolled in the United Kingdom. Upstream and catheter laboratory-initiated GPI were assumed to be tirofiban and abciximab, respectively. Life expectancy of first-year survivors, unit costs, and health-state utilities came from United Kingdom sources. Costs and effects were discounted at 3.5%. Incremental cost-effectiveness ratios (ICERs) were expressed as cost per quality-adjusted life year (QALY) gained.

RESULTS:

Higher acquisition costs for bivalirudin were partially offset by lower hospitalization and bleeding costs. In the ACUITY-based analysis, per-patient lifetime costs in the bivalirudin and heparin plus GPI strategies were £10,903 and £10,653, respectively. Patients survived 10.87 and 10.82 years on average, corresponding to 5.96 and 5.93 QALYs and resulting in an ICER of £9,906 per QALY gained. The GRACE-based ICER was £12,276 per QALY gained. In probabilistic sensitivity analysis, 72.1% and 67.0% of simulation results were more cost-effective than £20,000 per QALY gained, in the ACUITY-based and GRACE-based analyses, respectively. Additional scenario analyses implied that greater cost-effectiveness may be achieved in actual clinical practice.

CONCLUSIONS:

Treating NSTE-ACS patients undergoing invasive management with bivalirudin is likely to represent a cost-effective option for the United Kingdom, when compared with the current practice of using heparin and a GPI.

• Authors: Matthias Schwenkglenks, John E Brazier, Thomas D Szucs, Keith A A Fox
• Journal: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research (Value Health) Vol. 14 Issue 1 Pg. 24-33 (Jan 2011) ISSN: 1524-4733 [Electronic] United States
• PMID: 21211483 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Anticoagulants
• Hirudins
• Immunoglobulin Fab Fragments
• Peptide Fragments
• Platelet Glycoprotein GPIIb-IIIa Complex
• Pyridines
• Recombinant Proteins
• thienopyridine
• Tyrosine
• Heparin
• Tirofiban
• bivalirudin
• Abciximab

Topics

• Abciximab
• Acute Coronary Syndrome (drug therapy, economics, therapy)
• Antibodies, Monoclonal
• Anticoagulants (economics, therapeutic use)
• Cost-Benefit Analysis
• Decision Trees
• Drug Therapy, Combination
• Female
• Health Care Costs
• Heparin (economics, therapeutic use)
• Hirudins (economics)
• Humans
• Immunoglobulin Fab Fragments
• Male
• Middle Aged
• Models, Econometric
• Myocardial Revascularization
• Peptide Fragments (economics, therapeutic use)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Pyridines
• Quality-Adjusted Life Years
• Recombinant Proteins (economics, therapeutic use)
• Survival Analysis
• Tirofiban
• Tyrosine (analogs & derivatives)
• United Kingdom