Economic assessment of tirofiban in the management of acute coronary syndromes in the hospital setting; an analysis based on the PRISM PLUS trial

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 0·4μ.kg−1.min−1and a maintenance dose of 0·1μ.kg−1.min−1for tirofiban at a cost of CHF 273·55 (ECU 166·50) per vial. Heparin was administered at a loading dose of 5000U and a maintenance dose of 1000U.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 CHF23325 (ECU14198) and CHF18599 (ECU11321), respectively. The incremental drug costs amounted to CHF82065 (ECU49954). The additional use of tirofiban resulted in net savings of CHF54899 (ECU33418) per 100 patients, achieved through a reduction in the cost of treating refractory ischaemic conditions (CHF79306, ECU48275) and myocardial infarctions (CHF57658, ECU35097). Conclusion Tirofiban is cost-saving in acute coronary ischaemic syndromes and improves the economics of managing these patients during the initial hospitalizatio

Pharmakoökonomische Bewertung von Pravastatin in der koronaren Sekundärprävention bei Patienten mit Myokardinfarkt oder instabiler Angina Pectoris. Eine Analyse auf der Grundlage der LIPID-Studie [Pharmacoeconomic evaluation of pravastatin in coronary secondary prevention in patients with myocardial infarct or unstable angina pectoris. An analysis based on the LIPID Study]

BACKGROUND: Secondary coronary prevention with lipid lowering drugs have become a major issue in health policy formulation due to the large upfront investment in drug therapy. The recently completed LIPID trial with pravastatin in secondary prevention immediately raise the question whether pravastatin might be cost-effective in Switzerland. METHODS: We conducted a cost-effectiveness analysis from the perspective of third party payers. The following costs were included in the analysis: daily treatment costs of pravastatin, non fatal myocardial infarction, coronary bypass operations and stroke. Life years gained was obtained by applying the declining exponential approximation of life expectancy. All calculations were standardized to 1000 treated patients. RESULTS: The net costs of treating 1000 patients (i.e. drug costs minus the costs of sequelae and interventions) are Fr. 3.6 Mio. In addition, a total of 430 life-years may be saved through treatment. The corresponding cost-effectiveness of pravastatin treatment is Fr. 8341 (nominal) Fr. 6985 (discounted). CONCLUSIONS: The results suggest that the cost-effectiveness of pravastatin in secondary prevention lie well within the threshold of other commonly accepted medical interventions and may be considered an economically viable approach for secondary coronary prevention

Determinants of costs and resource utilization associated with open heart surgery

Aims This study sought to determine the patient- and the therapy-related determinants of in-hospital costs for patients undergoing heart surgery at the University Hospital in Zurich. Methods and Results We performed a retrospective analysis of all adult cardiac surgical patients from the canton St. Gallen who were covered by a fixed fee arrangement (29500 Swiss francs (19470 Euro)) and referred to our institution during 1998. A total of 201 patients (143 (71%) male) with basic insurance were hospitalized in 1998 under the fixed fee arrangement. The mean age of the patients was 61·4 years (95% confidence intervals (CI): 60; 63). With the help of univariate analysis, the following pre-operative characteristics were found to be significantly associated with cost: age (P<0·001), pre-operative cardiac diagnosis (coronary vs valvular heart disease) (P<0·001) and EuroSCORE (P<0·0001). A significant correlation was also found between intra-operative variables and costs (P<0·0001) as well as between postoperative variables and costs (P<0·0001). A linear regression model based on EuroSCORE, operation time and postoperative infection status is able to predict costs for patients (all P -values <0·0001, except for P<0·05 for operation time, R2=0·565). Conclusions These results suggest that both pre-operative (patient related) and intra-operative (therapy- and patient-related) variables are predictors of costs in cardiac surgical patient