A comparison of total hospital costs for percutaneous coronary intervention patients receiving abciximab versus tirofiban

Abstract

The purpose of this study was to examine the total hospital costs associated with the receipt of abciximab versus tirofiban for percutaneous coronary intervention (PCI) patients. Hospital billing data for patients with a primary procedure of PCI was examined for the period of July 1998 to June 1999 from HCIA-Sach's Clinical Pathways Database. Data were analyzed for all patient discharges whose records indicated use of abciximab or tirofiban with a PCI. Results are reported for 3,967 patients. Multivariate analysis was used to control for a wide range of factors (GP IIb/IIIa selection, patient demographics, stent use, insurance type, health conditions, admission information, and hospital characteristics) that may influence the cost of hospitalization. A two-stage sample selection model was used to estimate total costs. The first stage of the analysis utilizes a probit regression to determine the factors associated with the likelihood of receiving abciximab versus tirofiban. The second stage of the analysis examines the factors associated with total hospital costs, while controlling for unobserved factors that may be correlated with the patient's likelihood of receiving abciximab. The mean unadjusted cost per hospitalization, including drug costs, was $10,762 (abciximab $10,813 and tirofiban $10,567). After controlling for high-risk indications and selection bias with the two-stage sample selection model, results indicate there was no significant difference in costs associated with the receipt of abciximab versus tirofiban. However, the results also indicate that the two-stage sample selection model may not be needed (lambda was not statistically significant) hence, the cost equation was reestimated using ordinary least-squares methodology (OLS). In the OLS analysis, receipt of abciximab versus tirofiban was associated with a significant reduction in costs ($470 reduction; P = 0.05). This study uses real-world data to examine the total hospital costs for PCI patients who receive abciximab versus tirofiban. Results of the two-stage sample selection model indicate there is no difference in total hospital costs (including drug costs) between abciximab- and tirofiban-treated patients. If the results of the OLS model are considered, a slight decrease in total hospital costs is observed in abciximab recipients. Cost-containment strategies that focus on component costs may not lead to intended overall cost savings.

Evaluating the Generalisability of Trial Results: Introducing a Centre- and Trial-Level Generalisability Index

“…Given that the real-world RCT case study was a UK surgical trial, we searched for factors relevant to hospital care. The following characteristics were included in the Gix: bed capacity [15,[21][22][23], teaching function [21,[24][25][26][27], market environment [28,29], cost performance and the degree of specialisation [30,31] (Table 1). Market environment was operationalised using the UK Department of Health Market Forces Factor (MFF), a metric that accounts for three main categories of capital costs: labour (nonmedical staff and medical staff), land and buildings [32].…”

The Role of Risk Stratification in the Decision to Provide Upstream Versus Selective Glycoprotein IIb/IIIa Inhibitors for Acute Coronary Syndromes

“…The cost assigned to each 10-mg vial of abciximab was $450, with an assumption of a mean of three vials used per patient (i.e., $1,350) (17)(18)(19)(20). The cost ($1,060) assigned to upstream small molecule GP IIb/IIIa inhibitor was based on the mean cost of drug in the Treat angina with Aggrastat and determine Cost of Therapy with Invasive or Conservative Strategy (TACTICS) trial (median duration of therapy ϭ 48 h in the invasive arm) (21).…”

Choice of GPIIb/IIIa antagonist in percutaneous coronary intervention: how should economic criteria be factored in?

“…A retrospective US study on 5,560 patients undergoing PCI treated with an GIIb/IIIa antagonist found that the mean hospital stay was 4.32 days for tirofiban and 3.34 days for abciximab, i.e., a difference of 1 day 16 . This reduction in hospital stay undoubtedly offset the excess cost of abciximab, since the same authors, in another similar study, found that the total hospital costs were identical for the two products, around US$l0000 in 1999 values 17 .…”