Economic Evaluation of Bivalirudin With or Without Glycoprotein IIb/IIIa Inhibition Versus Heparin With Routine Glycoprotein IIb/IIIa Inhibition for Early Invasive Management of Acute Coronary Syndromes
Duane S. Pinto, MD, FACC*,**,*,
Gregg W. Stone, MD, FACC ,
Chunxue Shi, MS**,,
Elizabeth S. Dunn, MPH**,
Matthew R. Reynolds, MD, MSc*,**,
Meghan York, MD*,
Joshua Walczak, BA**,
Ronna H. Berezin, MPH**,
Roxana Mehran, MD, FACC,
Brent T. McLaurin, MD, FACC ,
David A. Cox, MD, FACC||,
E. Magnus Ohman, MD, FACC¶,
A. Michael Lincoff, MD, FACC ,
David J. Cohen, MD, MSc, FACC#,** on behalf of the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Investigators
* Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
Cleveland Clinic Foundation, Cleveland, Ohio
AnMed Health, Anderson, South Carolina
|| Lehigh Valley Hospital, Allentown, Pennsylvania
¶ Duke University Medical Center, Durham, North Carolina
# Mid-America Heart Institute, Kansas City, Missouri
** Harvard Clinical Research Institute, Brookline, Massachusetts
i3 Statprobe/UHG, Ann Arbor, Michigan
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Figure 1 Bootstrap Analysis of Index Hospital Stay Costs
Performance of 1,000 bootstrap replicates indicates a 94.6% probability of cost savings with bivalirudin monotherapy compared with heparin (unfractionated or low-molecular weight heparin) with upstream glycoprotein IIb/IIIa receptor inhibition (GPI) (yellow line) and a 68.3% probability of lower cost with bivalirudin monotherapy compared with heparin (unfractionated or low molecular weight heparin) and catheterization laboratory (cath lab)-initiated GPI (black line).
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Figure 2 Bootstrap Analysis of 30-Day Costs
Performance of 1,000 bootstrap replicates indicates an 85.3% probability of cost savings with bivalirudin monotherapy compared with heparin (unfractionated or low molecular weight heparin) with upstream GPI (yellow line) and a 57.4% probability of lower cost with bivalirudin monotherapy compared with heparin (unfractionated or low molecular weight heparin) and catheterization laboratory-initiated GPI (black line). Abbreviations as in Figure 1.
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Figure 3 Stratified Analyses of Aggregate 30-Day Costs by Treatment Group According to Pre-Specified Patient Characteristics
The graph indicates the mean difference in costs between the bivalirudin and heparin (unfractionated or low molecular weight heparin) + upstream glycoprotein IIb/IIIa receptor inhibitor (GPI) (black squares) along with the associated 95% confidence interval (bars). No interaction p values were significant, indicating that the overall treatment effect represents the most meaningful treatment effect for these subgroups (all p values for interaction >0.05).
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Figure 4 Stratified Analyses of Aggregate 30-Day Costs by Treatment Group According to Pre-Specified Patient Characteristics
The graph indicates the mean difference in costs between the bivalirudin and heparin (unfractionated or low molecular weight heparin) + catheterization laboratory-initiated GPI (black squares) along with the associated 95% confidence interval (bars). There was no evidence of heterogeneity of treatment effect across any of the subgroups (all p values for interaction >0.05). CrCI = creatinine clearance; TRS = Thrombolysis In Myocardial Infarction risk score; other abbreviations as in Figure 1.
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