Is Abciximab Worth the Cost?

Drug & Ther Perspect 13(5):13-16, 1999

	Abciximab is one of a new class of blood 
thinners. It inhibits the platelet glycoprotein (GP)
2b/3a receptor. Clinical trials have shown that 
abciximab, in combination with heparin and aspirin,
reduces the risk of ischemic complications in the 
first 30 days after revascularization surgery, like 
bypass. The high cost of this drug may be offset by
the avoidance of ischemic complications and repeat 
procedures. However, the costs associated with 
bleeding complications caused by abciximab must be
taken into account.
	Economic data were collected in the first 
major abciximab trial. This trial, EPIC (Evaluation
of Platelet 2b/3a Antibody for Preventing Ischemic
Complications of High Risk Angioplasty trial), 
involved 2099 patients having revascularization. 
They were all at high risk of acute complications.
Hospital costs and inpatient doctor fees were tracked
for the procedure and for 6 months followup. This 
was in 1991 and 1992. Outpatient costs and indirect 
costs were not included.
	The purchase price of abciximab (average 
dose) was $1407 per patient, $293 higher in abciximab
patients than placebo patients over the 6 months.
Rehospitalization and revascularisation during the 
follow-up period were lower in abciximab patients and
this largely offset the drug's purchase price.
	
	Cost-effectiveness studies support abciximab
use in high-risk patients only. The purchase price of
abciximab was largely offset by reduced costs for 
repeat procedures in the 6 month follow up period. 
However, whether this will also happen in most patients
in realclinical practice is unclear. Clinical trials
after EPIC have NOT confirmed a long-term benefit in the 
form of less repeat procedures down the road.
	Careful selection of patients is likely to 
improve cost effectiveness. In the high-risk patients
in the EPIC trial, abciximab was best for those at 
the highest risk of ischemic complications - patients
who were having a procedure to treat recent heart 
attack or unstable angina. Abciximab may also be good
in those patients for whom the average cost of 
procedures is high, such as diabetics.

What about Rescue Use?

	In lower risk patients, abciximab is currently
used only if complications develop during a procedure
(rescue use). This is a common practice, even though 
data to support the approach are lacking.
	
The Real World

	All of these issues were highlighted by a 
study of the costs and outcomes of 124 patients who 
were treated with the drug in October of 1996 to June 
of 1997, in the USA. 409 high-risk patients were 
controls. Costs included total direct medical costs 
for the initial procedure and for readmission in the
following 6 months.
	Total costs for the acute care period were 
higher by $3992 and outcome was worse in patients 
treated with abciximab. Abciximab recipients were 
more likely to need bypass surgery within 6 months.
	But when the analysis was limited to the 
highest risk patients, abciximab produced cost savings.