Importance of on-site catheterization facilities in the cost saving potential of GPIIb/IIIa inhibitors for acute coronary syndrome: Results from PURSUIT

Background: To examine the effect of on-site cardiac catheterization facilities (CC) on the medical care costs and resource use in the PURSUIT trial in Western Europe (WE) and the USA. Methods: Hospitals participating in the PURSUIT trial were sorted based upon presence of an on-site CC lab. The rate of procedures were calculated for the WE and USA subgroups Unit costs were developed in WE countries and UB-92 bills were obtained in the USA to estimate the cost per patient treated during the index hospital stay. Results: The CC rate in hospitals without CC labs was 36% in WE and 70% in the USA. In hospitals with CC labs, the CC rate was 72% in WE and 87% in the USA. A 1% or less absolute difference in CC and revascularization procedure rates was observed between eptifibatide patients versus placebo patients in the hospitals with CC labs. In hospitals without CC labs, an absolute difference of 3% to 6% fewer CC and revascularization procedures was observed with eptifibatide. Patient outcomes at 30 days were not different for the two types of hospitals. A 1% absolute lower death and MI endpoint was observed for eptifibatide patients in WE and 3.5% in the USA. Patient costs were consistently lower in the non-CC lab hospitals. Excluding drug therapy, treatment costs were 19%-24% lower in the eptifibatide group compared to placebo (Euro 1800 vs Euro 2100) in WE and 10% lower in USA ($15,300 vs $16,900 including hospital stay) in hospitals without CC labs. Conclusions: The IIa/IIIb inhibitor eptifibatide appears to have a greater impact on decreasing procedure rates and costs in hospitals without on-site CC laboratories.

Duke Scholars

Author Daniel Benjamin Mark Medicine, Cardiology