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(Circulation. 2000;101:366.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Cost-Effectiveness of Platelet Glycoprotein IIb/IIIa Inhibition With Eptifibatide in Patients With Non–ST-Elevation Acute Coronary Syndromes

Daniel B. Mark, MD, MPH; Robert A. Harrington, MD; A. Michael Lincoff, MD; Robert M. Califf, MD; Charlotte L. Nelson, MS; Anastasios A. Tsiatis, PhD; Hope Buell, MS; Kenneth W. Mahaffey, MD; Linda Davidson-Ray, BA; Eric J. Topol, MD

From The Duke Clinical Research Institute, Duke University Medical Center (D.B.M., R.A.H., R.M.C., C.L.N., A.A.T., H.B., K.W.M., L.D.-R.), Durham, NC; The Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; and The Department of Statistics, North Carolina State University (A.A.T.), Durham, NC.

Correspondence to Daniel B. Mark, MD, MPH, Professor of Medicine, Duke University Medical Center, Box 3485, Durham, NC 27710. E-mail daniel.mark{at}duke.edu

Background—In the PURSUIT trial, eptifibatide significantly reduced the 30-day incidence of death and myocardial infarction relative to placebo in 9461 patients with an acute coronary syndrome (unstable angina or non–Q-wave myocardial infarction).

Methods and Results—We conducted a 2-part prospective economic substudy of the 3522 US patients enrolled in PURSUIT: (1) an empirical intention-to-treat comparison of medical costs (hospital plus physician) up to 6 months after hospitalization and (2) a lifetime cost-effectiveness analysis. The base-case cost-effectiveness ratio was expressed as the 1996 US dollars required to add 1 life-year with eptifibatide therapy. The 2 treatment arms had equivalent resource consumption and medical costs (exclusive of the cost of the eptifibatide regimen) during the index (enrollment) hospitalization (P=0.78) and up to 6 months afterward (P=0.60). The average wholesale price of the eptifibatide regimen was $1217, but a typical hospital discounted price was $1014. The estimated life expectancy from randomization in the US patients was 15.96 years for eptifibatide and 15.85 years for placebo, an incremental difference of 0.111. The incremental cost-effectiveness ratio for eptifibatide therapy in US PURSUIT patients was $16 491 per year of life saved. This result was robust through a wide range of sensitivity analyses. The cost-utility ratio for eptifibatide (using time trade-off defined utilities) was $19 693 per added quality-adjusted life-year.

Conclusions—Based on the results observed in the US PURSUIT patients, the routine addition of eptifibatide to standard care for non–ST-elevation acute coronary syndrome patients is economically attractive by conventional standards.

Key Words: coronary disease • cost-benefit analysis • glycoproteins • eptifibatide

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