Using Triple Antiplatelet Therapy in Patients with Non-ST Elevation Acute Coronary Syndrome Managed Invasively- A Cost-Effectiveness Analysis

Sep 1, 2008, 00:00 AM
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Section Order : 7
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To assess the incremental cost-effectiveness ratio (ICER) of glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) pretreated with aspirin and clopidogrel undergoing an early invasive treatment strategy.


Cost-effectiveness analysis and cost-utility analysis were performed from a health-care system perspective, based on a Markov model with a time horizon of the patient life span. The risk of death and ischemic events was assessed using the Thrombolysis in Myocardial Infarction (TIMI) risk score. We compared three strategies: 1) routine upstream use of a GPIIb/IIIa inhibitor to all patients before angiography, 2) deferred selective use of abciximab in the catheterization laboratory just before angioplasty, and 3) double antiplatelet therapy without GPIIb/IIIa inhibitors. Both univariate sensitivity analysis and second-order probabilistic microsimulation were performed.


In the base case (65 years old, TIMI score 3), strategy A was the most effective, with an ICER of €15,150 per quality-adjusted life-year gained. Strategy B was dominated by a combination of strategies A and C. The ICER was very sensitive to the age and baseline risk of the patient. According to the widely accepted cost-effectiveness thresholds, strategy A would be cost-effective only in patients with an intermediate to high TIMI score, especially within the younger age groups. The probability that strategy A was cost-effective under the base case was 91.2%.


The use of GPIIb/IIIa inhibitors upstream in high-risk NSTE-ACS patients (TIMI score ≥3) pretreated with aspirin and clopidogrel is cost-effective, particularly in the younger age groups.
HEOR Topics :
  • Cardiovascular Disorders
  • Cost/Cost of Illness/Resource Use Studies
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision Modeling & Simulation
  • Economic Evaluation
  • Specific Diseases & Conditions
  • Study Approaches
Tags :
  • acute coronary syndrome
  • clopidogrel
  • cost-effectiveness
  • glycoprotein IIb/IIIa inhibitors
Regions :
  • Eastern and Central Europe
  • Western Europe