The addition of tirofiban to heparin and aspirin resulted in net savings of CHF 54,899 per 100 patients with acute coronary ischemic syndromes during the initial 7-day hospitalization.
Does tirofiban plus heparin and aspirin reduce direct healthcare costs compared to heparin and aspirin alone in patients with acute coronary ischaemic syndromes?
Tirofiban added to heparin and aspirin is cost-saving for managing acute coronary ischaemic syndromes during initial hospitalization in Switzerland.
AIMS: We analysed whether generalized use of tirofiban plus heparin and aspirin might save direct healthcare costs, as compared with heparin and aspirin alone, in patients with acute coronary ischaemic syndromes in Switzerland. METHODS AND RESULTS: We conducted an incremental cost-consequence analysis from the perspective of the admitting hospital for the period of the first 7 days. Costs were analysed for the management of refractory ischaemic conditions and myocardial infarctions, including incremental days on the general ward or intensive care unit, as well as necessary revascularization procedures, and expressed in Swiss francs (CHF) and European currency units (ECU). Drug costs were based on a loading dose of 0.4 micro x kg(-1) x min(-1)and a maintenance dose of 0.1 micro x kg(-1) x min(-1)for tirofiban at a cost of CHF 273.55 (ECU 166.50) per vial. Heparin was administered at a loading dose of 5000 U and a maintenance dose of 1000 U x h(-1). All calculations were standardized to 100 treated patients. The costs of managing ischaemic complications were based on typical practice patterns in Swiss hospitals. The incremental costs per patient of managing unstable angina patients with recurrent ischaemia or myocardial infarction were calculated as CHF 23 325 (ECU 14 198) and CHF 18 599 (ECU 11 321), respectively. The incremental drug costs amounted to CHF 82 065 (ECU 49 954). The additional use of tirofiban resulted in net savings of CHF 54 899 (ECU 33 418) per 100 patients, achieved through a reduction in the cost of treating refractory ischaemic conditions (CHF 79 306, ECU 48 275) and myocardial infarctions (CHF 57 658, ECU 35 097). CONCLUSION: Tirofiban is cost-saving in acute coronary ischaemic syndromes and improves the economics of managing these patients during the initial hospitalization.
“I had the privilege to lead the PRISM-PLUS trial, which was the first large trial ever done to test the efficacy upfront use of a GP IIb/IIIa inhibitor in a high-risk ACS population. The trial demonstrated that tirofiban (AGGRASTAT®) added to standard therapy reduced the incidence of death and myocardial infarction at 48 hours (66% reduction), days (43% reduction) and 30 days (30% reduction). Importantly, the observed benefits applied to medically managed patients and to patients referred for percutaneous intervention (PCI) or CABG surgery as well.”
Szucs et al. (Wed,) conducted a other in acute coronary ischaemic syndromes. tirofiban plus heparin and aspirin vs. heparin and aspirin alone was evaluated on incremental cost-consequence (net savings). The addition of tirofiban to heparin and aspirin resulted in net savings of CHF 54,899 per 100 patients with acute coronary ischemic syndromes during the initial 7-day hospitalization.
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