Choice of GPIIb/IIIa antagonist in percutaneous coronary intervention: how should economic criteria be factored in?

OBJECTIVE: Three GPIIb/IIIa antagonists are available in the market. In France, as in many countries, their acquisition costs strongly differ. The objective of this study was to analyze how economic criteria-beyond the acquisition cost-should be factored in, when choosing a GPIIb/IIIa antagonist. METHOD: Both clinical and economic papers on the use of GPIIb/IIIa antagonists in percutaneous coronary interventions published in peer-review journals from 1994 to 2002 were reviewed and analyzed. RESULTS: Cost differentials between products strongly vary from one 'cost concept' to another, i.e., acquisition cost, administration cost, hospital cost, net treatment cost. The comparison of efficacy is even more complicated, as most of the time only indirect comparisons are available, based on different clinical studies, with different durations and definitions of outcomes. Finally, cost-effectiveness ratios range from US dollar 10,695 per avoided event for eptifibatide (IMPACT II study) to US dollar 74,047 for tirofiban (RESTORE study). CONCLUSION: The concept of cost, inevitably entering into the choice of a medicinal strategy, must be used with caution. The amplitude of the difference between products, and the product favored by the difference, vary according to the cost concept retained.