Cost-effectiveness of adjunctive eptifibatide in patients undergoing coronary stenting in Germany

Dewilde, Sarah; Brüggenjürgen, Bernd; Nienaber, Christoph; Senges, Jochen; Welte, R; Willich, Stefan N.

doi:10.1007/s10198-011-0310-6

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…In a retrospective US cost-effectiveness analysis that incorporated data from the ESPRIT trial and modeled life expectancy using a large cardiovascular database, eptifibatide was associated with a favorable cost-effectiveness ratio of $1,407 (2000 US dollars) per life-year gained. The cost-effectiveness of adding eptifibatide to unfractionated heparin for selected high-risk patients undergoing PCI in Germany was studied by Dewilde et al49 They showed that while eptifibatide was an additional expense initially, it recovers its cost by avoiding costly repeat procedures and preventing cardiovascular events, leading to positive quality-adjusted life-year gains. The incremental net benefit of its use exceeded €10,000 (about $13,000 in 2006 US dollars) from a hospital and a third-party payer perspective.…”

Section: Pharmacoeconomic Evaluationmentioning

confidence: 99%

Clinical and economic studies of eptifibatide in coronary stenting

Pasala

Sattayaprasert

Bhat

et al. 2014

TCRM

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Platelet adhesion and aggregation at the site of coronary stenting can have catastrophic clinical and economic consequences. Therefore, effective platelet inhibition is vital during and after percutaneous coronary intervention. Eptifibatide is an intravenous antiplatelet agent that blocks the final common pathway of platelet aggregation and thrombus formation by binding to glycoprotein IIb/IIIa receptors on the surface of platelets. In clinical studies, eptifibatide was associated with a significant reduction of mortality, myocardial infarction, or target vessel revascularization in patients with acute coronary syndrome undergoing percutaneous coronary intervention. However, recent trials conducted in the era of dual antiplatelet therapy and newer anticoagulants failed to demonstrate similar results. The previously seen favorable benefit of eptifibatide was mainly offset by the increased risk of bleeding. Current American College of Cardiology/American Heart Association guidelines recommend its use as an adjunct in high-risk patients who are undergoing percutaneous coronary intervention with traditional anticoagulants (heparin or enoxaparin), who are not otherwise at high risk of bleeding. In patients receiving bivalirudin (a newer safer anticoagulant), routine use of eptifibatide is discouraged except in select situations (eg, angiographic complications). Although older pharmacoeconomic studies favor eptifibatide, in the current era of P2Y12 inhibitors and newer safer anticoagulants, the increased costs associated with bleeding make the routine use of eptifibatide an economically nonviable option. The cost-effectiveness of eptifibatide with the use of strategies that decrease the bleeding risk (eg, transradial access) is unknown. This review provides an overview of key clinical and economic studies of eptifibatide well into the current era of potent antiplatelet agents, novel safer anticoagulants, and contemporary percutaneous coronary intervention.

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Section: Pharmacoeconomic Evaluationmentioning

confidence: 99%

Clinical and economic studies of eptifibatide in coronary stenting

Pasala

Sattayaprasert

Bhat

et al. 2014

TCRM

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“… 23 Post-acute benefits of eptifibatide in terms of reduced complications and re-intervention have also been shown with respect to quality-adjusted-life-years 24 and overall costs to third-party payers, all prior to the introduction of a generic formulation of the drug in 2016. 25 Cangrelor ( Kengreal ), a newer, intravenous P2Y12 inhibitor with a half-life of 3–5 min is another candidate synergistic dual antiplatelet bridging agent which merits discussion. 26 In randomized studies, cangrelor outperformed clopidogrel in reducing acute thrombogenic complications of coronary intervention and mortality without excess bleeding.…”

Section: Discussionmentioning

confidence: 99%

Eptifibatide bridging therapy for staged carotid artery stenting and cardiac surgery: Safety and feasibility

et al. 2022

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Background Prophylactic carotid artery stenting (CAS) is an effective strategy to reduce perioperative stroke in patients with severe carotid stenosis who require cardiothoracic surgery (CTS). Staging both procedures (CAS-CTS) during a single hospitalization presents conflicting demands for antiplatelet therapy and the optimal pharmacologic strategy between procedures is not established. The purpose of this study is to present our initial experience with a “bridging” protocol for staged CAS-CTS. Methods A retrospective review of staged CAS-CTS procedures at a single referral center was performed. All patients had multivessel coronary and/or valvular disease and severe carotid stenosis (>70%). Patients not previously on aspirin were also started on aspirin prior to surgery, followed by eptifibatide during CAS (intraprocedural bolus followed by post-procedural infusion which was continued until the morning of surgery). Pre- and perioperative (30 days) neurologic morbidity and mortality was the primary endpoint. Results 11 CAS procedures were performed in 10 patients using the protocol. The median duration of eptifibatide bridge therapy was 36 h (range 24–288 h). There was one minor bleeding complication (1/11, 9.1%) and no major bleeding complications during the bridging and post-operative period. There was one post-operative, non-neurologic death and zero perioperative ischemic strokes. Conclusions For patients undergoing staged CAS-CTS, Eptifibatide bridging therapy is a viable temporary antiplatelet strategy with a favorable safety profile. This strategy enables a flexible range of time-intervals between procedures.

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“…Thus, eptifibatide being much cheaper than abciximab on Polish pharmaceutical market, may be an attractive, cost saving alternative in the treatment of high-risk STEMI patients. Complete costeffectiveness analysis of the use of eptifibatide as an adjunct therapy to high-risk percutaneous coronary angioplasty was published recently [16]. Dewilde et al have analyzed the subpopulation of high-risk patients undergoing implantation of stent from the ESPRIT trial [17] with patient-level utility data from a published Dutch study [18].…”

Section: Discussionmentioning

confidence: 99%

“…The authors have concluded that eptifibatide is likely to be a dominant strategy leading to quality-adjusted life years gained and generating cost savings from both the hospital and the third-party payer perspective. Eptifibatide offsets its additional treatment costs by avoiding costly repeat procedures and leads to positive quality-adjusted life years gained by preventing cardiovascular events lending themselves to transient or permanent lower quality of life [16]. However, the direct translation of these results into clinical practice of STEMI management is impossible, because of completely different populations in our and ESPRIT studies, the advent of drug eluting stent era, new oral antiplatelet drugs and recommendation for transradial access with reduced bleeding risk [19].…”

Section: Discussionmentioning

confidence: 99%