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Cost-effectiveness of coronary stenting and abciximab for patients with acute myocardial infarction: results from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial.

Publication ,  Journal Article
Bakhai, A; Stone, GW; Grines, CL; Murphy, SA; Githiora, L; Berezin, RH; Cox, DA; Stuckey, T; Griffin, JJ; Tcheng, JE; Cohen, DJ ...
Published in: Circulation
December 9, 2003

BACKGROUND: Both stenting and the glycoprotein IIb/IIIa inhibitor abciximab improve outcomes for patients undergoing primary angioplasty for acute myocardial infarction (AMI). However, the cost-effectiveness of these strategies is unknown. METHODS AND RESULTS: We performed a prospective cost-utility analysis among US participants in the CADILLAC trial. Patients with AMI (n=1703) were randomized to stenting versus balloon angioplasty (PTCA) and abciximab versus no abciximab according to a 2-by-2 factorial design. Total 1-year costs and lifetime incremental cost-effectiveness ratios, measured as cost per quality-adjusted year of life (QALY) gained, were calculated. Compared with PTCA, stenting increased procedural costs by 1148 dollars and initial hospital costs by 1384 dollars (both P<0.001). By 1-year, stenting led to fewer repeat revascularization procedures and reduced follow-up medical care costs by 1215 dollars, such that aggregate costs were similar for the PTCA and stent groups (18 690 dollars versus 18 859 dollars, P=0.75). The cost-effectiveness ratio for stenting versus PTCA was favorable at 11 237 dollars/QALY gained and remained <20 000 dollars/QALY in sensitivity analyses. Compared with standard anticoagulation, abciximab increased initial procedural costs by 1122 dollars (P<0.001). By facilitating accelerated hospital discharge, abciximab reduced length of stay by approximately 0.6 days, offsetting most of the drug costs. These cost offsets were not maintained, however; aggregate 1-year costs for the abciximab group were 1244 dollars greater than for standard therapy (19 389 dollars versus 18 145 dollars , P=0.02). Abciximab was reasonably cost-effective (cost-effectiveness ratio 21 305 dollars/QALY) only if nonsignificant differences in 1-year mortality (3.7% versus 4.3%, P=0.62) were incorporated in the analysis. CONCLUSIONS: Primary stenting is a highly cost-effective treatment for AMI. The cost-effectiveness of abciximab in this setting is uncertain and depends primarily on whether long-term survival is enhanced.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

December 9, 2003

Volume

108

Issue

23

Start / End Page

2857 / 2863

Location

United States

Related Subject Headings

  • Survival Analysis
  • Stents
  • Recurrence
  • Prospective Studies
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Length of Stay
  • Immunoglobulin Fab Fragments
 

Citation

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Bakhai, A., Stone, G. W., Grines, C. L., Murphy, S. A., Githiora, L., Berezin, R. H., … CADILLAC Investigators, . (2003). Cost-effectiveness of coronary stenting and abciximab for patients with acute myocardial infarction: results from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial. Circulation, 108(23), 2857–2863. https://doi.org/10.1161/01.CIR.0000103121.26241.FA
Bakhai, Ameet, Gregg W. Stone, Cindy L. Grines, Sabina A. Murphy, Louise Githiora, Ronna H. Berezin, David A. Cox, et al. “Cost-effectiveness of coronary stenting and abciximab for patients with acute myocardial infarction: results from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial.Circulation 108, no. 23 (December 9, 2003): 2857–63. https://doi.org/10.1161/01.CIR.0000103121.26241.FA.
Bakhai A, Stone GW, Grines CL, Murphy SA, Githiora L, Berezin RH, Cox DA, Stuckey T, Griffin JJ, Tcheng JE, Cohen DJ, CADILLAC Investigators. Cost-effectiveness of coronary stenting and abciximab for patients with acute myocardial infarction: results from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial. Circulation. 2003 Dec 9;108(23):2857–2863.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

December 9, 2003

Volume

108

Issue

23

Start / End Page

2857 / 2863

Location

United States

Related Subject Headings

  • Survival Analysis
  • Stents
  • Recurrence
  • Prospective Studies
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Length of Stay
  • Immunoglobulin Fab Fragments