(Circulation. 2000;102:392.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Targeting Patients Undergoing Angioplasty for Thrombus Inhibition
A Cost-Effectiveness and Decision Support Model
Presented in part at the 46th Annual Scientific Sessions of the American College of Cardiology, Anaheim, Calif, March 16 through 19, 1997.
From the Division of Cardiology, Department of Medicine, Emory University School of Medicine (W.S.W., T.D.T., E.M.); the Departments of Health Policy and Management (W.S.W., S.C., E.R.B.) and Biostatistics (A.S.K.), Rollins School of Public Health, Emory University, Atlanta, Ga; and Outcomes Research and Management, Merck & Co, Inc, West Point, Pa (S.J.B.).
Correspondence and reprint requests to William S. Weintraub, MD, Division of Cardiology, Emory University, WMB 319, 1639 Pierce Dr, Atlanta, GA 30322. E-mail bill{at}hp3.eushc.org
Background—In recent clinical trials, glycoprotein IIb/IIIa blockers have demonstrated effectiveness in preventing adverse events after angioplasty in high-risk patients. However, uncertainty exists regarding the cost-effective selection of patients to receive antiplatelet therapy.
Methods and Results—All 4962 patients at Emory University Hospitals who underwent coronary intervention procedures (n=6062) from 1993 to 1995 were studied. Multivariate models to predict death and the composite of death, Q-wave and non-Q-wave myocardial infarction, and emergency additional revascularization were developed. Hospital costs and professional costs were determined. A cost-effectiveness analysis with therapy targeted to high-risk patients was performed. If patients with a >5% probability of events received antiplatelet therapy that reduced events by 24% and cost $1000, 40.1% of patients would receive therapy; complications would be reduced from 6.39% to 5.37%, and cost would increase $261 from $10 343 to $10 604, or $25 504 per event prevented. The marginal cost per event prevented by moving from a 7% to a 5% probability of an event cutoff would be $57 799.
Conclusions—For high-risk patients, there may be cost savings; for low-risk patients, therapy may not be cost effective; and for patients in the midrange (between 5% and 7% probability of an adverse event), events may be prevented at an acceptable level of cost.
Key Words: angioplasty • platelet aggregation inhibitors • cost-benefit analysis
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