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CLINICAL STUDIES

Economic impact of GPIIB/IIIA blockade after high-risk angioplasty

Results from the restore trial

William S. Weintraub, MD^*, Steven Culler, PhD, Stephen J. Boccuzzi, PhD^||, John R. Cook, PhD^||, Andrzej S. Kosinski, PhD, David J. Cohen, MD, Joy Burnette, RN^* for the RESTORE Trial Study Group

^* Emory Center for Outcomes Research, Division of Cardiology, Department of Medicine, Atlanta, Georgia, USA
Department of Health Policy and Management, Atlanta, Georgia, USA
Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
Beth Israel Hospital, Harvard University School of Medicine, Boston, Massachusetts, USA
^|| Outcomes Research and Management, Health Economics Statistics, Merck & Co., Inc., Whitehouse Station, New Jersey, USA

Manuscript received December 22, 1998; revised manuscript received May 4, 1999, accepted June 11, 1999.

Reprint requests and correspondence: William S. Weintraub, MD, Division of Cardiology, Emory University, 1639 Pierce Drive, WMB 319, Atlanta, GA 30322
bill{at}hp3.eushc.org

OBJECTIVE

This study was conducted to assess the impact of GPIIb/IIIa blockade with tirofiban on costs during the initial hospitalization and at 30 days among patients undergoing high-risk coronary angioplasty.

BACKGROUND

GPIIb/IIIa blockers are a new class of compounds that have been shown in clinical studies to prevent complications after high-risk angioplasty.

METHODS

The RESTORE trial was a multinational, blinded placebo-controlled study of 2,197 patients randomized to tirofiban or placebo following coronary angioplasty. This economic assessment was a prospective substudy of the RESTORE trial, and included 1,920 patients enrolled in the U.S. Costs were estimated for the U.S. cohort based on their utilization of healthcare resources and on costs measured directly in 820 U.S. patients at 30 sites.

RESULTS

There was a 36% difference in the rate of the composite event of death, myocardial infarction (MI) and revascularization at two days between tirofiban and placebo (8% vs. 12%, p = 0.002). This difference was attributed to a reduction in nonfatal MI, repeat angioplasty, coronary surgery and stent placement. These clinical benefits followed a similar trend at 30 days, with a 16% reduction in the composite event (p = 0.10). In-hospital cost, including professional and study drug costs, was $12,145 ± 5,882 with placebo versus $12,230 ± 5,527 with tirofiban (p = 0.75). The 30-day cost was $12,402 ± 6,147 with placebo versus $12,446 ± 5,814 with tirofiban (p = 0.87).

CONCLUSIONS

Tirofiban has been shown to decrease in-hospital and possibly 30-day events after high-risk angioplasty. The beneficial clinical effects of tirofiban in high-risk patients can be achieved at no increased cost.

Abbreviations and Acronyms   EPIC = Evaluation of 7E3 for the Prevention of Ischemic Complications   EPILOG = Evaluation of PTCA to Improve Long-Term Outcome by C7ES GPIIb/IIIa Receptor blockade   IMPACT = Integrilin to Minimize Platelet Aggregation and Prevent Coronary Thrombosis   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   RESTORE = Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis trial   RVUs = resource value units

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