Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of acute ST-segment elevation myocardial infarction. Issue 7 (7th February 2012)

• Record Type: Journal Article
• Authors: Schwenkglenks, Matthias; Toward, Toby J; Plent, Stephanie; Szucs, Thomas D; Blackman, Daniel J; Baumbach, Andreas
• Is Part Of: Heart. Volume 98:Issue 7(2012)
• Page Start: 544
• Page End: 551
• Publication Date: 2012-02-07
• Subjects: Myocardial infarction -- anticoagulants -- bivalirudin -- cost-benefit analysis -- United Kingdom -- EBM -- public health -- epidemiology -- clinical trials -- coronary intervention -- intravascular ultrasound -- acute myocardial infarction -- interventional cardiology -- coronary stenting -- excimer laser -- cardiac imaging -- coronary pressure; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2011-301323
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To assess the cost-effectiveness of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitor (H-GPI) in patients undergoing primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI), from a UK health service perspective. Design: Cost-utility analysis with life-long time horizon. Main outcome measures: Costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness. Methods: Event risks and medical resource use data derived from the HORIZONS-AMI trial were entered into a decision analytic model. Clinical events until the end of year 1 (main model) or year 3 (alternative model) were modelled in detail. Adjustments were applied to approximate UK routine practice characteristics. Life expectancy of 1-year or 3-year survivors, health-state utilities, initial hospitalisation length of stay in the comparator strategy and unit costs were based on UK sources. Costs and effects were discounted at 3.5%. Results: The main model predicted bivalirudin and H-GPI patients to survive 11.52 and 11.35 (undiscounted) years on average, respectively, and to accrue 6.26 and 6.17 QALYs. Patient lifetime costs were £267 lower in the bivalirudin strategy (£12 843 vs £13 110). Extensive sensitivity and scenario analyses confirmed these results to be robust. In probabilistic analysis, quality-adjusted survival was higher and costs were lower with bivalirudin in 95.0% of simulation runs. In 99.2%, cost-effectiveness was better than £20 000 per QALY gained. Results from the alternative model were fully consistent. Conclusion: The use of bivalirudin instead of H-GPI in STEMI patients undergoing PPCI is cost-effective, and offers a high probability of dominance. Background treatment with aspirin and clopidogrel is assumed.