, Volume 16, Issue 6, pp 711–741 | Cite as


A Pharmacoeconomic Review of its Use in Percutaneous Coronary Revascularisation
Adis Pharmacoeconomic Drug Evaluation



Abciximab is a monoclonal antibody fragment that inhibits platelet aggregation through antagonism of glycoprotein IIb/IIIa. The drug is used in conjunction with heparin and aspirin to prevent ischaemic complications associated with percutaneous coronary revascularisation in patients with coronary heart disease

Large and well designed clinical studies have shown abciximab, as an adjunct to aspirin and heparin, to reduce by around one-third to one-half the incidence of ischaemic complications within 30 days of percutaneous coronary revascularisation. Use of the drug appears advantageous in patients at high risk, and abciximab also reduces complications in patients undergoing coronary stenting, although the drug does not appear to inhibit restenotic tissue volume within stents. Longer term benefit has also been reported, with emerging 1-year data from a study in patients at all levels of risk showing reductions in a composite end-point of death, myocardial infarction (MI) or urgent repeat revascularisation. Three-year benefit has been reported in high risk patients. Meta-analysis results, and 1-year data from patients receiving stents, have shown reduced mortality with abciximab.

Abciximab therapy had an incremental cost over standard therapy from a hospital perspective of $US293 per patient (1991/1992 values) over 6 months in a prospective economic substudy from a major US clinical trial of the drug in high risk patients. Abciximab was cost saving in patients with unstable angina. A mean net cost of hospitalisation of $US476 per patients (1995 costs) has been shown in a further study in patients with a broad range of levels of risk, and observational data indicate reduced duration of hospitalisation with abciximab.

Cost-effectiveness data favoured abciximab with aspirin and heparin over a 6-month period in Spanish and Dutch analyses in which data from the above trial were combined with local cost data, but not in an Australian analysis. Subgroup analyses have indicated enhanced cost effectiveness in high risk patients. Available data also show clinical benefit and cost effectiveness of abciximab therapy in conjunction with coronary stent placement.

Conclusions: Data indicate intravenous bolus plus 12-hour infusion regimens of abciximab to be economically viable in patients at high or low risk of ischaemic complications after percutaneous coronary revascularisation. The drug has been shown to be cost effective in patients receiving the drug in conjunction with coronary stents, and subgroup analyses indicate additional cost effectiveness in certain groups of patients at high risk of ischaemic complications (notably those with acute MI and unstable angina).

Cost of Illness

The main pharmacoeconomic value of abciximab is in reducing or eliminating the costs associated with the complications of percutaneous coronary revascularisation. By the mid-1990s, at least 800 000 percutaneous coronary revascularisation procedures were being performed worldwide each year. According to 1993/1994 US data, the average total per-patient charge incurred during initial hospitalisation for percutaneous transluminal coronary angioplasty is $US27 100 for patients with a primary diagnosis of acute myocardial infarction (MI) and $US19 300 for patients without such a diagnosis. In the year following the procedure, the average per-patient hospital costs or charges are approximately $US2000 to $US5000

In general, the strongest influencing factor on total initial hospitalisation costs for patients undergoing percutaneous coronary procedures is the development of ischaemic complications. Acute ischaemic complications can increase initial inhospital costs 1.5- to 4-fold, compared with an uncomplicated procedure. Late complications related to restenosis may substantially increase total costs by necessitating repeat revascularisation procedures.

A recently introduced strategy to reduce the complications of percutaneous coronary revascularisation is elective coronary stenting, now used in more than 50% of coronary revascularisation procedures in the US. The increased initial hospitalisation costs associated with stenting are largely offset by lower follow-up costs resulting from reduced complication rates.

Clinical Profile

Abciximab, as an adjunct to heparin and aspirin, reduces by about one-third to one-half the incidence of ischaemic complications (death, MI or urgent coronary intervention) occurring within 30 days of percutaneous coronary revascularisation, according to large, placebo-controlled trials. The need for urgent coronary intervention (percutaneous coronary revascularisation or coronary artery bypass surgery) and the incidence of MI are reduced. Abciximab appears to be particularly effective in patients at the highest risk for ischaemic complications, i.e. those undergoing percutaneous coronary revascularisation for the treatment of unstable angina or acute MI, although benefit is also attained in patients with lower risk levels. The drug reduces acute ischaemic complications in patients undergoing elective coronary stenting. Reduced mortality risk has been shown bymeta-analysis of major studies in which abciximab was administered as an intravenous bolus followed by 12-hour infusion, and by 1-year data from patients receiving abciximab in conjunction with stenting

Long term (3-year) benefit in terms of reduced need for repeat revascularisation with abciximab was evident in a major trial (EPIC: Evaluation of Platelet IIb/IIIa Inhibition for Prevention of Ischemic Complications of High Risk Angioplasty study) involving high risk patients. The incidence of ischaemic complications was lower at 6 months in patients undergoing elective coronary stenting with abciximab than in those who received stents plus placebo in another major trial (EPISTENT: Evaluation of Platelet IIb/IIIa Inhibitor for Stenting study). Recent 6-month data from another study (ERASER: Evaluation of ReoPro and Stenting to Eliminate Restenosis) have shown no effect of abciximab on neointimal tissue proliferation measured by intravascular ultrasound in patients receiving stents, however. Emerging 1-year data from a study in patients at all levels of risk (EPILOG: Evaluation in PTCA to Improve Long-Term Outcome with Abciximab GPIIb/IIIa Blockade study) also show long term benefit in terms of a composite end-point of death, MI or urgent repeat revascularisation. Abciximab had no significant effect on the incidence of ischaemic complications or repeat revascularisation overall at 6 months in the CAPTURE (c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina) or RAPPORT (ReoPro and Primary PTCA Organization and Randomized Trial) studies, although the cumulative need for urgent repeat revascularisation was significantly reduced in the latter, and a post-procedure infusion of only 1 hour’s duration, which is no longer recommended, was used in the former. Additional benefit was obtained with abciximab in patients enrolled in EPILOG who required unplanned stent placement.

In line with its antiplatelet activity, the most significant adverse effects associated with abciximab when used in combination with heparin and aspirin are bleeding complications and thrombocytopenia. Although bleeding complications were a significant concern with the first major trial of abciximab to be conducted (EPIC), bleeding can be minimised by adherence to the recommended protocol for abciximab administration. With this protocol, the rate of major bleeding complications in abciximab recipients in clinical trials was ≤2% and was not significantly different than that in placebo recipients. Careful patient selection, meticulous femoral artery access site care, use of a low dose, bodyweight-adjusted heparin regimen, and early removal of the arterial sheath are recommended.

The incidence of thrombocytopenia (platelet count <100 000/μl) in patients treated with abciximab was approximately 2.5 to 5.6%, compared with 1.3 to 3.3% in placebo recipients, in major trials. Severe thrombocytopenia (platelet count <50 000/μl) has been noted in up to 1.6 and 0.7% of abciximab and placebo recipients, respectively.

Pharmacoeconomic Considerations

Pharmacoeconomic investigations of abciximab have been driven by the need to identify net resource gains that may be made through the avoidance or reduction of costs associated with ischaemic complications after index percutaneous coronary revascularisation. Such resource savings may partly or fully offset the acquisition cost of the drug

Results of a prospective economic substudy (in which hospital costs, inpatient physician fees and drug acquisition costs were considered) carried out in conjunction with the major clinical trial of abciximab in high risk patients (EPIC) showed use of the drug (bolus plus infusion) to result in an incremental cost compared with standard care of $US293 per patient over 6 months (1991/1992 values). Abciximab was cost saving in patients with unstable angina in a subgroup analysis.

Prospective economic data from EPILOG (patients at all levels of risk of ischaemic complications) collected over the 6 months after the index procedure have shown a mean net cost of hospitalisation of $US476 per patient (1995 costs). Almost 65% of the cost of the drug was offset by avoidance of additional procedures. Favourable cost data have also been shown in modelled analyses, and the adoption of the widespread use of abciximab and coronary stents in 1 institution has been associated with a 28% reduction in the mean total per patient hospital cost. Statistically significant reductions in length of hospital stay have also been demonstrated with abciximab by retrospective analyses of hospital billing data from a US managed-care organisation.

Cost issues associated with the use of abciximab have also been investigated in institution-specific analyses carried out in the US. A proportional hazards model applied in a retrospective study in patients with unstable coronary syndromes showed abciximab treatment to be associated with reduced need for revascularisation within 2 weeks of the index procedure, with a corresponding reduction in costs per case over 6 months.

Six-month efficacy and safety data from EPIC have been applied in a number of local cost-effectiveness analyses. The average cost per patient free from a serious ischaemic event or repeat revascularisation favoured abciximab with aspirin and heparin over aspirin and heparin alone in Spanish and Dutch studies, but not in an Australian analysis. Incremental cost-effectiveness estimates from these studies as well as a Canadian analysis were $US5804 (Spanish study; year of costing not stated), NLG5235 (Dutch guilders; 1992 to 1994 values), $A13 012 (Australian dollars; 1996 values) and $Can8840 (Canadian dollars; year of costing not stated). In a 10-year Australian Markov projection (5% annual discount rate and 1996 prices) the incremental cost per year of life gained (YLG) with abciximab versus standard therapy was $A5547. Other modelled scenarios produced estimates of cost per YLG of NLG8311 for all patients and NLG4156 for patients with unstable angina (1994 Dutch estimate) or $Can24 556 (year of costing not stated).

A combination of 6-month efficacy results from an analysis of 4 major clinical trials in patients from all risk groups undergoing percutaneous coronary revascularisation with hospital costs in a Canadian analysis yielded a net cost per event (MI or repeat revascularisation) prevented of $Can 27 000. Overall, subgroup analyses have indicated that abciximab is likely to prove most cost effective in high risk patients, particularly those with unstable angina or acute MI.

Abciximab reduces the incidence of ischaemic complications in patients undergoing elective coronary stenting and may have favourable pharmacoeconomics when used in this setting. Six-month data from the EPISTENT study in patients receiving coronary stents with or without abciximab have shown the drug to be cost effective from a payer perspective. The absolute reduction in mortality at 6 months in patients who received abciximab was 0.74%. The cost per YLG with abciximab was estimated to be $US17 318 (based on an incremental drug cost of abciximab of $US1472 and a gain of 0.85 life years with the drug); when the incremental cost of abciximab was set at its acquisition cost (3 vials: $US1350) in a sensitivity analysis, the cost per YLG was $US15 882 (year of costing not stated). Data from the 1-year analysis show reduction of the cost per YLG to $US9316.

On the basis of hospital billing data from the EPILOG study and an overall reduced relative risk of mortality, data from a meta-analysis of 6 major trials in which abciximab therapy was given as a bolus plus 12-hour infusion showed a cost per YLG of $US4664 in patients who received the drug. Despite the caution required in the interpretation of results of this type, the cost effectiveness of abciximab was favourable on the basis of commonly used thresholds of $US40 000 to $US50 000 per YLG. Preliminary observational data also indicate cost effectiveness of abciximab in ‘real-world’ practice settings.

Although available data show abciximab therapy to be economically attractive in broad populations of patients undergoing percutaneous coronary revascularisation, enhancement of cost effectiveness in high risk patients (notably those with acute MI or unstable angina) has been demonstrated by subgroup analyses.


Adis International Limited Unstable Angina Abciximab Ischaemic Complication Abciximab Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Foster RH, Wiseman LR. A bciximab: an updated review of its use in ischaemic heart disease. Drugs 1998; Oct 56: 629–65PubMedCrossRefGoogle Scholar
  2. 2.
    MacLeod MCM, Finlayson AR, Pell JP, et al. Geographic, demographic, and socioeconomic variations in the investigation and management of coronary heart disease in Scotland. Heart 1999; Mar 81: 252–6PubMedGoogle Scholar
  3. 3.
    Heart and stroke facts: 1996 statistical supplement. Dallas, Texas: American Heart Association, 1996Google Scholar
  4. 4.
    McGovern PG, Pankow JS, Shahar E, et al. Recent trends in acute coronary heart disease: mortality, morbidity, medical care, and risk factors. N Engl J Med 1996 Apr 4; 334: 884–90PubMedCrossRefGoogle Scholar
  5. 5.
    Woods KL, Ketley D, Agusti A, et al. Use of coronary angiography and revascularization procedures following acute myocardial infarction: a European perspective. Eur Heart J 1998 Sep; 19: 1348–54PubMedCrossRefGoogle Scholar
  6. 6.
    Van de Werf F, Topol EJ, Lee KL, et al. Variations in patient management and outcomes for acute myocardial infarction in the United States and other countries. Results from the GUSTO trial. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. JAMA 1995 May 24–31; 273: 1586–91Google Scholar
  7. 7.
    Pepine CJ, Holmes Jr DR, Block PC, et al. Coronary artery stents. J Am Coll Cardiol 1996 Sep; 28 (3): 782–94PubMedGoogle Scholar
  8. 8.
    Maynard C, Chapko MK, Every NR, et al. Coronary angioplasty outcomes in the Healthcare Cost and Utilization Project, 1993–1994. Am J Cardiol 1998 Apr 1; 81: 848–52CrossRefGoogle Scholar
  9. 9.
    Unstable Angina Guideline Panel. Diagnosing and managing unstable angina. Am Fam Physician 1994 May; 49 (6): 1459–75Google Scholar
  10. 10.
    Tonkin AM, Aroney CN. Guidelines for managing patients with unstable angina: rating the evidence and rationale for treatment. Med J Aust 1997 Jun 16; 166: 644–7Google Scholar
  11. 11.
    Task Force of the European Society of Cardiology. Management of stable angina pectoris: recommendations of the Task Force of the European Society of Cardiology. Eur Heart J 1997; 18: 394–413CrossRefGoogle Scholar
  12. 12.
    Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Acute myocardial infarction: pre-hospital and in-hospital management. Eur Heart J 1996; 17: 43–63Google Scholar
  13. 13.
    Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1996 Nov 1; 28 (5): 1328–428PubMedCrossRefGoogle Scholar
  14. 14.
    Hussain KMA, Estrada AQ, Kogan A, et al. Trends in success rate after percutaneous transluminal coronary angioplasty in men and women with coronary heart disease. Am Heart J 1997 Oct; 134: 719–27PubMedCrossRefGoogle Scholar
  15. 15.
    O’Meara JJ, Dehmer GJ. Care of the patient and management of complications after percutaneous coronary artery interventions. Ann Intern Med 1997; 127: 458–71PubMedGoogle Scholar
  16. 16.
    Califf RM. Restenosis: the cost to society. Am Heart J 1995 Sep; 130 (Pt 2): 680–4PubMedCrossRefGoogle Scholar
  17. 17.
    Weintraub WS, Ghazzal ZMB, Douglas Jr JS, et al. Long-term clinical follow-up in patients with angiographic restudy after sucessful angioplasty. Circulation 1993; 87: 831–40PubMedCrossRefGoogle Scholar
  18. 18.
    Ryan TJ. Management of acutemyocardial infarction. Synopsis of ACC and AHA practice guidelines. American College of Cardiology and American Heart Association. Postgrad Med 1997 Nov; 102: 84–8,91–3,96PubMedCrossRefGoogle Scholar
  19. 19.
    Eeckhout E, Wijns W, Meier B, et al. Indications for intracoronary stent placement: the European view. Eur Heart J 1999; 20: 1014–9PubMedCrossRefGoogle Scholar
  20. 20.
    Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 1994 Aug 25; 331: 489–95CrossRefGoogle Scholar
  21. 21.
    Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994 Aug 25; 331: 496–501CrossRefGoogle Scholar
  22. 22.
    Topol EJ. The stentor and the sea change. Am J Cardiol 1995 Aug 1; 76: 307–8CrossRefGoogle Scholar
  23. 23.
    The EPISTENT Investigators. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Lancet 1998 Jul 11; 352: 87–92CrossRefGoogle Scholar
  24. 24.
    Mak K-H, Belli G, Ellis SG, et al. Subacute stent thrombosis: evolving issues and current concepts. J AmColl Cardiol 1996 Feb; 27 (2): 494–503CrossRefGoogle Scholar
  25. 25.
    Goklaney AK, Murphy JD, Hillegass Jr WB. Abciximab therapy in percutaneous intervention: economic issues in the United States. Am Heart J 1998 Apr; 135: S90–7CrossRefGoogle Scholar
  26. 26.
    Hermiller J, Kereiakes DJ. Economic considerations in the use of the platelet GP IIb/IIIa inhibitor abciximab in percutaneous coronary intervention. Eur Heart J Supplements 1999; 1 Suppl. E: E43–8Google Scholar
  27. 27.
    Mark DB, Hlatky MA, Califf RM, et al. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med 1995 May 25; 332: 1418–24PubMedCrossRefGoogle Scholar
  28. 28.
    Lieu TA, Lundstrom RJ, Ray GT, et al. Initial cost of primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 1996 Oct; 28: 882–9PubMedCrossRefGoogle Scholar
  29. 29.
    Cohen DJ, Breall JA, Kalon KL, et al. Economics of elective coronary revascularization: comparison of costs and charges for conventional angioplasty, directional atherectomy, stenting and bypass surgery. J Am Coll Cardiol 1993 Oct; 22 (4): 1052–9PubMedCrossRefGoogle Scholar
  30. 30.
    Vaitkus PT, Witmer WT, Brandenburg RG, et al. Economic impact of angioplasty salvage techniques, with an empasis on coronary stents: a method incorporating costs, revenues, clinical effectiveness and payer mix. J Am Coll Cardiol 1997 Oct; 30 (4): 894–900PubMedCrossRefGoogle Scholar
  31. 31.
    Topol EJ, Ellis SG, Cosgrove DM, et al. Analysis of coronary angioplasty practice in the United States with an insurance claims data base. Circulation 1993 May; 87 (5): 1489–97PubMedCrossRefGoogle Scholar
  32. 32.
    Reeder GS, Bailey KR, Gersh BJ, et al. Cost comparison of immediate angioplasty versus thrombolysis followed by conservative therapy for acute myocardial infarction: a randomized prospective trial. Mayo Clin Proc 1994 Jan; 69: 5–12PubMedGoogle Scholar
  33. 33.
    de Boer MJ, van Hout BA, Liem AL, et al. A cost-effective analysis of primary coronary angioplasty versus thrombolysis for acute myocardial infarction. Am J Cardiol 1995 Oct 15; 76: 830–3CrossRefGoogle Scholar
  34. 34.
    Mark DB, O’Neill WW, Brodie B, et al. Baseline and 6-month costs of primary angioplasty therapy for acute myocardial infarction: results from the Primary Angioplasty Registry. J Am Coll Cardiol 1995 Sep; 26: 688–95PubMedCrossRefGoogle Scholar
  35. 35.
    Adele C, Vaitkus PT, Wells SK, et al. Cost advantages of an ad hoc angioplasty strategy. J Am Coll Cardiol 1998 Feb; 31: 321–5PubMedCrossRefGoogle Scholar
  36. 36.
    Popma JJ, Redwood SR, Chuang YC, et al. Procedure-related complications are the major contributors of incremental in hospital costs after angioplasty [abstract]. Circulation 1995 Oct 15; 92 (8 Suppl. I): I-662Google Scholar
  37. 37.
    Hillegass WB. The economics of IIb/IIIa therapy. J Invasive Cardiol 1996; 8 Suppl. B: 30B-3BGoogle Scholar
  38. 38.
    McShane KJ, Sung CH, Ligon RW, et al. In-hospital and one year clinical outcomes and economic impact after infarct artery stenting or balloon angioplasty following systemic thrombolysis for acute myocardial infarction [abstract]. Am J Cardiol 1998 Oct; 82 Suppl.: 115SGoogle Scholar
  39. 39.
    van’t Hof AWJ, Suryapranata H, de Boer M-J, et al. Costs of stenting for acute myocardial infarction [letter]. Lancet 1998 Jun 13; 351: 1817CrossRefGoogle Scholar
  40. 40.
    Cohen DJ, Krumholz HM, Sukin CA, et al. In-hospital and one-year economic outcomes after coronary stenting or balloon angioplasty: results from a randomized clinical trial. Circulation 1995 Nov 1; 92 (9): 2480–7PubMedCrossRefGoogle Scholar
  41. 41.
    Guetta V, Lincoff AM. Clinical experience with abciximab duringcoronary revascularisation: an overview. Biodrugs 1998 Jul; 10: 27–39PubMedCrossRefGoogle Scholar
  42. 42.
    Kleiman NS. A risk-benefit assessment of abciximab in angioplasty. Drug Saf 1999 Jan; 20 (1): 43–57PubMedCrossRefGoogle Scholar
  43. 43.
    The EPIC Investigators. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. N Engl J Med 1994 Apr 7; 330 (14): 956–61CrossRefGoogle Scholar
  44. 44.
    Topol EJ, Califf RM, Weisman HF, et al. Randomised trial of coronary intervention with antibody against platelet IIb/IIIa integrin for reduction of clinical restenosis: results at six months. Lancet 1994 Apr 9; 343: 881–6CrossRefGoogle Scholar
  45. 45.
    Faulds D, Sorkin EM. Abciximab (c7E3 Fab): a review of its pharmacology and therapeutic potential in ischaemic heart disease. Drugs 1994 Oct; 48: 583–98PubMedCrossRefGoogle Scholar
  46. 46.
    Brener SJ, Barr LA, Burchenal JEB, et al. Randomized, placebo- controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acutemyocardial infarction. Circulation 1998 Aug 25; 98: 734–41CrossRefGoogle Scholar
  47. 47.
    The EPILOG Investigators. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med 1997 Jun 12; 336 (24): 1689–96CrossRefGoogle Scholar
  48. 48.
    The CAPTURE Investigators. Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. Lancet 1997 May 17; 349: 1429–35CrossRefGoogle Scholar
  49. 49.
    Lincoff AM, Califf RM, Moliterno DJ, et al. Complementary clinical benefits of coronary-artery stenting and blockade of platelet glycoprotein IIb/IIIa receptors. N Engl J Med 1999 Jul 29; 341 (5): 319–27PubMedCrossRefGoogle Scholar
  50. 50.
    Neumann F-J, Kastrati A, Dirschinger J, et al. Use of platelet glycoprotein IIb/IIIa blockade in acute myocardial infarction treated with intracoronary stenting: 30-day clinical results of a randomized study [abstract]. J Am Coll Cardiol 1999 Feb; 33 (2) Suppl. A: 338Google Scholar
  51. 51.
    Topol EJ, Ferguson JJ, Weisman HF, et al. Long-term protection from myocardial ischemic events in a randomized trial of brief integrin 3 blockade with percutaneous coronary intervention. JAMA 1997 Aug 13; 278: 479–84CrossRefGoogle Scholar
  52. 52.
    Lincoff AM, Tcheng JE, Califf RM, et al. Sustained suppression of ischemic complications of coronary intervention by platelet GP IIb/IIIa blockade with abciximab. One-year outcome in the EPILOG trial. Circulation 1999 Apr 20; 99: 1951–8CrossRefGoogle Scholar
  53. 53.
    Anderson KM, Ferguson III JJ, Stoner GL, et al. Long-term mortality benefit with abciximab in patients undergoing percutaneous coronary intervention (PCI) [abstract]. Circulation 1997 Oct 21; 96 (96) Suppl.: 162Google Scholar
  54. 54.
    Anderson KM, Ferguson III JJ, Stoner GL, et al. Mortality among treated patients in PCI studies randomizing patients tostandard therapy plus placebo or ReoPro with 12-hour infusion post PCI [poster presentation]. 70th Annual Scientific Sessions of the American Heart Association; 1997 Nov 9–12; Orange County Convention Center, OrlandoGoogle Scholar
  55. 55.
    Topol EJ, Byzova TV, Plow EF. Platelet GPIIb-IIIa blockers. Lancet 1999 Jan 16; 353: 227–31CrossRefGoogle Scholar
  56. 56.
    The ERASER Investigators. Acute platelet inhibition with abciximab does not reduce in-stent restenosis (ERASER study). Circulation 1999 Aug 24; 100: 799–806CrossRefGoogle Scholar
  57. 57.
    Kereiakes DJ, Lincoff AM, Miller DP, et al. Abciximab therapy and unplanned coronary stent deployment: favorable effects on stent use, clinical outcomes, and bleeding complications. Circulation 1998; 97: 857–64PubMedCrossRefGoogle Scholar
  58. 58.
    Aguirre FV, Topol EJ, Anderson KM, et al. Clinical benefit within patient subgroups receiving c7E3 Fab (abciximab) during percutaneous coronary revascularization: subgroup analysis from the EPIC trial. J Invasive Cardiol 1996; 8 Suppl. B: 21B-9BGoogle Scholar
  59. 59.
    Kleiman NS, Lincoff AM, Kereiakes DJ, et al. Diabetes mellitus, glycoprotein IIb/IIIa blockade, and heparin: evidence for a complex interaction in a multicenter trial. Circulation 1998 May 19; 97: 1912–20CrossRefGoogle Scholar
  60. 60.
    Narins CR, Ellis SG, Hammel JP. Does abciximab improve outcome following angioplasty in diabetics? Long-term follow-up results from the EPIC study [abstract]. Circulation 1997 Oct 21; 96 Suppl.: 162Google Scholar
  61. 61.
    Hamm CW, Heeschen C, Goldmann B, et al. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med 1999 May 27; 340 (21): 1623–9PubMedCrossRefGoogle Scholar
  62. 62.
    Lincoff AM, Califf RM, Anderson KM, et al. Evidence for preventionof death and myocardial infarction with platelet membrane glycoprotein IIb/IIIa receptor blockade by abciximab (c7E3 Fab) among patients with unstable angina undergoing percutaneous coronary revascularization. EPIC Investigators. Evaluation of 7E3 in Preventing Ischemic Complications. J Am Coll Cardiol 1997 Jul; 30: 149–56PubMedCrossRefGoogle Scholar
  63. 63.
    Ferguson JJ, Kereiakes DJ, Adgey AA, et al. Safe use of platelet GP IIb/IIIa inhibitors. Eur Heart J 1998 Apr; 19 Suppl. D: D40–51Google Scholar
  64. 64.
    Deckers J, Califf RM, Topol EJ, et al. Use of abciximab (ReoPro) is not associated with an increase in the risk of stroke: overview of three randomized trials [abstract]. J Am Coll Cardiol 1997 Feb; 29 Suppl. A: 241AGoogle Scholar
  65. 65.
    Berkowitz SD, Harrington RA, Rund MM, et al. Acute profound thrombocytopenia after c7E3 Fab (abciximab) therapy. Circulation 1997 Feb 18; 95: 809–13CrossRefGoogle Scholar
  66. 66.
    Tcheng JE, Kereiakes DJ, Braden GA, et al. Readministration of abciximab: interim report of the Reo Pro Readministration Registry. Am Heart J 1999 Jul; 138 (1): S33–8CrossRefGoogle Scholar
  67. 67.
    Aristides M, Gliksman M, Rajan N, et al. Effectiveness and cost effectiveness of single bolus treatment with abciximab (Reo Pro) in preventing restenosis following percutaneous transluminal coronary angioplasty in high risk patients. Heart 1998 Jan; 79: 12–7PubMedGoogle Scholar
  68. 68.
    Bala MV, Anderson KM, Barber BL, et al. Abciximab is cost-effective in patients undergoing percutaneous coronary intervention with stents [abstract]. J Am Coll Cardiol 1999 Feb;33 Suppl. A: 15Google Scholar
  69. 69.
    Motheral B, Ramsey S, Crown W, et al. Panel 3: methodological issues in conducting pharmacoeconomic evaluations - retrospective and claims database studies. Value Health 1999 Mar/Apr; 2 (2): 82–7CrossRefGoogle Scholar
  70. 70.
    Mark DM, Talley JD, Topol EJ, et al. Economic assessment of platelet glycoprotein IIb/IIIa inhibition for prevention of ischemic complications of high-risk coronary angioplasty. Circulation 1996 Aug 15; 94: 629–35CrossRefGoogle Scholar
  71. 71.
    Lincoff AM, Mark DB, Califf RM, et al. Economic assessment of platelet glycoprotein IIb/IIIa receptor blockade during coronary intervention in the EPILOG trial [abstract]. J Am Coll Cardiol 1997 Feb; 29 Suppl. A: 240AGoogle Scholar
  72. 72.
    Clinical study report. EPILOG health economic sub study. Protocol C0116T16. Malvern, PA. Centocor Inc. 1998. (Data on file)Google Scholar
  73. 73.
    Anderson KM, Cabot CF, Tcheng JE. Abciximab reduces in hospital events among patients undergoing percutaneous coronary intervention [abstract TCT-177]. Am J Cardiol 1999 Sep 22; 84 Suppl. 6A: 67pGoogle Scholar
  74. 74.
    Abernathy GB, Hewitt KK. Cost and outcomes analysis of abciximab use in a community teaching hospital. Am J Health System Pharm 1998 Dec 15; 55 Suppl. 4: 35–7Google Scholar
  75. 75.
    Lucore CL, Trask RV, Mishkel GJ, et al. Impact of abciximab and stents on outcomes and economics in a community hospital [abstract]. J Am Coll Cardiol 1998 Feb; 31 Suppl. 2A: 200ACrossRefGoogle Scholar
  76. 76.
    Lucore CL, Trask RV, Mishkel GJ, et al. Outcomes and economics associated with use of abciximab in patients 70 years undergoing coronary interventions [abstract]. J Am Coll Cardiol 1998 Feb; 31 Suppl. 2A: 445ACrossRefGoogle Scholar
  77. 77.
    Lundstrom RJ, Jindeel A, Colby CJ, et al. Abciximab in unstable coronary syndromes: benefits and costs in a group model nonprofit health maintenance organization [poster presentation]. 48th Annual Scientific Session of the American College of Cardiology (ACC); 1999 Mar 7–10; New OrleansGoogle Scholar
  78. 78.
    Kereiakes DJ. Preferential benefit of platelet glycoprotein IIb/IIIa receptor blockade: specific considerations by device and disease state. Am J Cardiol 1998 Apr 9; 81: 49E-54ECrossRefGoogle Scholar
  79. 79.
    Brener SJ, Ellis SG, DeLuca S, et al. Abciximab in coronary angioplasty - comparison of planned and rescue administration [abstract]. J Invasive Cardiol 1997; 9 Suppl. C: 50CGoogle Scholar
  80. 80.
    Kugler I, Gaudron P, Homdasch M, et al. Abciximab used as “bail-out drug” is safe at lower cost compared to the recommended pretreatment in high-risk angioplasty [abstract]. Eur Heart J 1998 Aug; 19 Suppl.: 46Google Scholar
  81. 81.
    Lage M, Barber B, Bowman L, et al. The use of abciximab for percutaneous transluminal coronary angioplasty patients enrolled in managed care organizations [abstract]. Value Health 1999 May-Jun; 2 (3): 137–8CrossRefGoogle Scholar
  82. 82.
    Cameron A. Abciximab: ’real-world’ outcomes and prescribing patterns. Pharmacoecon Outcomes News 1999 Jul 10 (220): 3–5Google Scholar
  83. 83.
    Lage MJ, Barber BL, Bowman W, et al. Shorter hospital stays for angioplasty patients who receive abciximab [abstract]. J Am Coll Cardiol 1999; 33 (2) Suppl. A: 286AGoogle Scholar
  84. 84.
    Cabot CF, Anderson KM, Tcheng JE, et al. Abciximab reducesprocedure time among patients undergoing percutaneous coronary intervention [abstract TCT-188]. Am J Cardiol 1999 Sep 22; 84 Suppl. 6A: 71pGoogle Scholar
  85. 85.
    Sacristán JA, Navarro O, Huete T, et al. Cost-effectiveness of the monoclonal antibody c7E3 in high-risk coronary angioplasty in Spain. Br J Med Econ 1996; 10: 169–83Google Scholar
  86. 86.
    van Hout BA, Simoons ML. Costs and effects of c7E3 in high risk PTCA patients. An indirect analysis for The Netherlands. Eur Heart J 1995 Nov; 16 Suppl L: 81–5PubMedGoogle Scholar
  87. 87.
    Oh PI, Pritchard-Oh L, Cohen EA. Cost-effectiveness analysis of abciximab used in PTCA from a Canadian hospital perspective [abstract]. Can J Cardiol 1997 Sep; 13 Suppl. C: 104CGoogle Scholar
  88. 88.
    Commonwealth of Australia. Manual of resource items and their associated costs: for use in submissions to the Pharmaceutical Benefits Advisory Committee involving economic analysis. Canberra: Department of Health, Housing, Local Government and Community Services, 1993Google Scholar
  89. 89.
    Serruys PW, Herrman J-PR, Simon R, et al. A comparison of hirudin with heparin in the prevention of restenosis after coronary angioplasty. N Engl J Med 1995 Sep 21; 333 (12): 757–63PubMedCrossRefGoogle Scholar
  90. 90.
    van Hout BA, Bowman L, Zelinger DJ, et al. Costs and effects in therapy for acute coronary syndromes: the case of abciximab in high-risk patients undergoing percutaneous transluminal coronary angioplasty in the EPIC study. Evaluation of 7E3 for the Prevention of Ischemic Complications. Am Heart J 1998 Apr; 135 (4): S98–106CrossRefGoogle Scholar
  91. 91.
    van Hout BA, Al M, Gordon GS, et al. Costs, effects and C/Eratios alongside a clinical trial. Health Econ 1994; 3: 309–19PubMedCrossRefGoogle Scholar
  92. 92.
    Zed PJ, Frighetto L, Sunderji R, et al. Cost-effectiveness analysis of abciximab: aCanadian hospital perspective. Ann Pharmacother 1998 May; 32: 536–42PubMedCrossRefGoogle Scholar
  93. 93.
    McGregor M, Brophy JM. Use of abciximab (c7E3 Fab, ReoPro) as an adjunct to balloon angioplasty. Can J Cardiol 1999 Feb; 15: 201–7PubMedGoogle Scholar
  94. 94.
    Reed SO, Mullins CD, Magder LS. Use of confidence intervals to estimate the cost-effectiveness of abciximab [abstract]. Value Health 1999 May-Jun; 2 (3): 167CrossRefGoogle Scholar
  95. 95.
    Bala MV, Anderson KM, Barber BL, et al. Abciximab is cost-effective in patients undergoing percutaneous coronary intervention with stents [poster presentation]. 48th Annual Scientific Session of the American College of Cardiology (ACC); 1999 Mar 7–10; New OrleansGoogle Scholar
  96. 96.
    Mark DB. Medical economics in cardiovascular medicine. In: Topol EJ, editor. Textbook of cardiovascular medicine. Philadelphia: Lippincott-Raven, 1998: 1033–61Google Scholar
  97. 97.
    Mauskopf JA, Bala MV, Hermiller J, et al. Cost-effectiveness of abciximab in percutaneous coronary intervention patients: results from a meta-analysis [abstract]. Value Health 1999 May-June; 2: 153CrossRefGoogle Scholar
  98. 98.
    Mauskopf JA, Bala MV, Hermiller J, et al. Cost-effectiveness of abciximab in percutaneous coronary intervention patients: results from a meta-analysis [poster presentation]. 4th annual international meeting of the International Society for Pharmacoeconomics and Outcomes Research; 1999 May 23–26; Arlington, VAGoogle Scholar
  99. 99.
    Elsinga E, Rutten FFH. Economic evaluation in support of national health policy: the case of The Netherlands. Soc Sci Med 1997; 45: 605–20PubMedCrossRefGoogle Scholar
  100. 100.
    Heeschen C, Hamm CW, Goldmann BU, et al. Cost effectiveness of abciximab in patients with unstable angina according to the troponin T status [abstract]. Circulation 1998 Oct 27; 98 Suppl. I: I-358-I-359Google Scholar
  101. 101.
    Bowman L. Using national and institutional economic data to target most cost-effective use of abciximab. Formulary 1996 Mar; 31: 186–96Google Scholar
  102. 102.
    Brophy JM, Sleight P. Enthusiasm, reality, and cost-effectiveness analysis. Heart 1998 Jan; 79: 9–11PubMedGoogle Scholar
  103. 103.
    Aristides M, Gliksman M. Murmurs from the heart (or why the stethoscope is not an economic tool). Heart 1998 Jan; 79: 10–1PubMedGoogle Scholar
  104. 104.
    News from the 8th International ISCP Congress. Pharmacoecon Outcomes News 1999 May 15 (212): 8–9Google Scholar
  105. 105.
    Price DJ, Campbell PG, Grech ED, et al. Abciximab in coronary stenting: routine use cannot be justified [abstract]. Cardiovasc Drugs Ther 1999 March; 13 (1): 28Google Scholar
  106. 106.
    Fitzgerald ST, Merrill A, Aversano T, et al. Direct and indirect cost of percutaneous transluminal coronary angioplasty. Cardiology 1994; 85: 298–302PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.Adis International LimitedMairangi Bay, Auckland 10New Zealand

Personalised recommendations