Glycoprotein IIb/IIIa inhibitor drugs (abciximab and eptifibatide)
Disease or Condition
Blood clots (thrombi) and atherosclerotic plaque can block the coronary artery supplying blood to the heart. Blockage may result in heart pain (angina) or acute coronary syndrome, including unstable angina and myocardial infarction. Percutaneous coronary interventions (PCI) are medical procedures during which a catheter (a slender tube) is threaded through the skin into a coronary artery to relieve the blockage. Antiplatelet therapy and “scaffold-like” coronary stents embedded in the artery wall at the time of the PCI help prevent immediate clotting and later renarrowing of the artery due to scar tissue formation. However, procedural complications related to thrombus formation can still occur after a PCI with stenting.
Glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor drugs block receptors on the platelet membrane to prevent activation and clumping, which are key factors in thrombus formation and other complications after PCIs.
Using GP IIb/IIIa inhibitors as adjunct therapy in PCI with stenting can reduce post-procedural re-narrowing and complications, but the costs may be significantly increased. An economic evaluation is needed to assess the cost-effectiveness.
To review the economic evidence on the use of GP IIb/IIIa inhibitors as adjunct therapy in PCI with stenting.
To perform economic evaluations from a Canadian provincial health insurance payer perspective on the cost-effectiveness of abciximab and eptifibatide.
Full economic evaluations that compared PCI alone to PCI with abciximab or eptifibatide were identified in a literature search. Five studies met the inclusion criteria for the review. Decision analytic modelling was done to estimate the short-term and long-term cost-effectiveness of the two drugs.
Compared to stenting alone, eptifibatide plus stenting reduced costs to a provincial payer by an average of $59 per procedure in patients requiring elective and urgent PCI. Overall death and serious cardiac outcomes were improved in the short term (one year) and over a lifetime (average of 0.12 adjusted life-years) in all patients.
Compared to stenting alone, abciximab plus stenting increased costs to a provincial payer by an average of $1,171 per procedure in patients requiring elective and urgent PCI. Overall death and serious cardiac outcomes were improved in the short term (one year) and over a lifetime (average of 0.07 adjusted life-years) in all patients.
The use of these drugs in patients with diabetes compared with non-diabetic patients may reduce overall costs and improve health outcomes (average 0.22 adjusted life-years observed for both drugs).