A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists

Abstract

et al. A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists. Health Technol Assess 2002;6(25). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA Programme T he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. The research reported in this monograph was commissioned by the HTA Programme on behalf of the National Institute for Clinical Excellence (NICE). Technology assessment reports are completed in a limited time to inform the appraisal and guidance development processes managed by NICE. The review brings together evidence on key aspects of the use of the technology concerned. However, appraisals and guidance produced by NICE are informed by a wide range of sources. The research reported in this monograph was funded as project number 00/04/02. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme, NICE or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

???Lost in Translation???

“…For further details about this model the reader is invited to refer to the original publications. [82, 89]…”

Quality-adjusted life-years as decisionmaker tools to address limitations inherent in number-needed-to-treat/harm values

“…This does not often weigh heavily to a practicing clinician but is watched closely by administrative personnel owing to its potential impact upon cost-containment strategies. We identified two research articles from clinical trial results describing the cost-effectiveness of GPRAs for the treatment of non-STEMI [12,13]. The first study was based upon results from PURSUIT and showed a small gain in QALY of 0.01 (0.84 vs 0.83; p = 0.45) in the aggressive medical management alone versus aggressive management plus eptifibitide.…”

“…A summary of CEA research concluded that cost-effectiveness results were dependent upon risk stratification, that is, implementing treatment among patients who are most likely to benefit over time [14]. A health technology assessment review concluded that the CEA study results of GPRAs were suspect owing to the use of disease-specific end points rather than QALYs, differences in US versus UK health services, and an inability or failure to incorporate benefits beyond the study duration [12]. We also searched clinical guidelines for examples in which GPRAs were presented in terms of cost-effectiveness.…”

The Role of Glycoprotein IIb/IIIa Inhibitors- A Promise Not Kept?

“…Most cost-effectiveness studies have not determined the cost of mortality reduction. Instead these studies focused on preventing merely ischemic events [ 42 , 43 ] or combination of ischemic events and mortality[ 44 ] and have not disclosed the entire spectrum of adverse events of GPI on clinical outcome[ 45 ]. The health benefits of reducing CPK leaks or NQWMI is difficult to define.…”