Assessing the value of newer pharmacologic agents in non-ST elevation patients: a decision support system application

Proc AMIA Annu Fall Symp. 1997;273-7.

Abstract

Newer pharmacologic agents have demonstrated significant clinical and economic benefit in high-risk percutaneous transluminal coronary angioplasty (PTCA) patients. However, the higher costs of these agents may prohibit their use in lower-risk coronary artery disease (CAD) populations. We developed a decision support system (DSS) to determine the level of clinical effectiveness these newer agents must exhibit to be either cost-neutral or cost-effective in non-ST elevation patients. Our DSS evaluated six month cumulative costs, increased years of life saved (YOLS), and lifetime cost-effectiveness. We found that these therapies can cost as much as $1500 and be cost-neutral at six months if they reduce the composite endpoint of death, myocardial infarction (MI), or revascularization by 15%, and they may cost as much as $3000 and be cost-effective if they reduce this endpoint by 10%.

MeSH terms

  • Abciximab
  • Angioplasty, Balloon, Coronary
  • Antibodies, Monoclonal / economics*
  • Antibodies, Monoclonal / therapeutic use
  • Coronary Disease / economics
  • Coronary Disease / mortality
  • Coronary Disease / physiopathology
  • Coronary Disease / therapy*
  • Cost-Benefit Analysis
  • Decision Support Systems, Clinical*
  • Decision Support Techniques
  • Drug Therapy, Computer-Assisted*
  • Electrocardiography
  • Humans
  • Immunoglobulin Fab Fragments / economics*
  • Immunoglobulin Fab Fragments / therapeutic use
  • Platelet Aggregation Inhibitors / economics*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
  • Quality-Adjusted Life Years
  • Survival Analysis
  • Value of Life

Substances

  • Antibodies, Monoclonal
  • Immunoglobulin Fab Fragments
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Abciximab