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Spotlight on Eptifibatide in Percutaneous Coronary Intervention and Acute Coronary Syndromes

  • Adis Spotlight
  • Published:
Disease Management & Health Outcomes

Abstract

Eptifibatide (Integrilin®) is a selective inhibitor of platelet glycoprotein IIb/IIIa receptors used as adjunctive therapy for patients undergoing percutaneous coronary intervention (PCI) and for patients with acute coronary syndromes (ACS), particularly those requiring PCI. Most economic analyses of eptifibatide have incorporated clinical and healthcare resource use data from either the ESPRIT (Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin® Therapy) study in low- to moderate-risk patients undergoing selective PCI with stent implantation or the PURSUIT (Platelet Glycoprotein Ilb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin® Therapy) trial in patients with ACS. Eptifibatide achieved statistically significant reductions in combined endpoints of death and ischemic complications in both of these large multicenter clinical trials, in which patients were randomized to receive intravenous eptifibatide or placebo as adjunctive therapy to heparin and aspirin (plus a thienopyridine in ESPRIT).

In US economic analyses using ESPRIT trial data, approximately 40% and 70% of the acquisition cost of eptifibatide was offset by reduced medical resource consumption during the initial hospitalization period and over a 1-year period, respectively. Eptifibatide was associated with a favorable cost-effectiveness ratio of $US1407 (year 2000 values) per life-year gained (LYG) in a retrospective US cost-effectiveness analysis that incorporated data from the ESPRIT trial and modeled life expectancy using a large cardiovascular database.

Several cost-effectiveness analyses used prospectively collected data from the PURSUIT trial and modeled survival projections using similar methods. These analyses, conducted in the US, Canada, and Western Europe, also showed favorable results ($US3761-$US18 774 per LYG; various years of costing). Cost-utility ratios reported in US analyses varied somewhat, but remained <$US20 000 per quality-adjusted life-year gained (1996 values) when clinical efficacy data were derived from the US cohort of PURSUIT.

In conclusion, significant clinical benefits have been demonstrated with eptifibatide as adjunctive therapy in patients undergoing selective PCI with stent implantation in the ESPRIT trial and in patients with ACS in the PURSUIT trial. Pharmacoeconomic analyses using data from either ESPRIT or PURSUIT have demonstrated favorable cost-effectiveness ratios for both indications in various countries. ESPRIT-based results from the limited number of available economic analyses are particularly favorable. The cost-effectiveness of eptifibatide in ACS (i.e. PURSUIT-based results) may be further improved by targeting the drug for patients in whom catheterisation and PCI are planned, although further analyses are required to confirm this.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Popma JJ, Ohman EM, Weitz J, et al. Antithrombotic therapy in patients undergoing percutaneous coronary intervention. Chest 2001; 119 Suppl.: 321S–36S

    Article  PubMed  CAS  Google Scholar 

  2. American Heart Association. 2001 Heart and Stroke Statistical Update: heart attack and angina statistics [online]. Available from URL: http://www.americanheart.org [Accessed 2002 Jun 4]

  3. Truong KM, Amankwa K, Kucukarslan S. Platelet glycoprotein IIb/IIIa-receptor inhibitors in patients with acute coronary syndromes or undergoing percutaneous coronary interventions: a review. Clin Ther 2001 Aug; 23(8): 1145–65; discussion 1129

    Article  PubMed  CAS  Google Scholar 

  4. Bhatt DL, Topol EJ. Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes. JAMA 2000 Sep 27; 284(12): 1549–58

    Article  PubMed  CAS  Google Scholar 

  5. Cannon CP. Glycoprotein Ilb/IIIa inhibitors in unstable angina and non-ST segment elevation myocardial infarction. Coron Artery Dis 1999; 10(8): 561–6

    Article  PubMed  CAS  Google Scholar 

  6. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina) [online]. Available from URL: http://www.acc.org [Accessed 2002 Jun 4]

  7. Cohen DJ, O’shea JC, Pacchiana CM, et al. In-hospital costs of coronary stent implantation with and without eptifibatide (the ESPRIT trial): Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin. Am J Cardiol 2002 Jan 1;89(1): 61–4

    Article  Google Scholar 

  8. Eisenstein EL, Shaw LK, Anstrom KJ, et al. Assessing the clinical and economic burden of coronary artery disease: 1986–1998. Med Care 2001 Aug; 39(8): 824–35

    Article  PubMed  CAS  Google Scholar 

  9. Lefkovits J, Plow EF, Topol EJ. Platelet glycoprotein IIb/IIIa receptors in cardiovascular medicine. N Engl J Med 1995; 332: 1553–9

    Article  PubMed  CAS  Google Scholar 

  10. Goa KL, Noble S. Eptifibatide: a review of its use in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention. Drugs 1999 Mar; 57(3): 439–62

    Article  PubMed  CAS  Google Scholar 

  11. Dery JP, O’shea JC, Tcheng JE. Eptifibatide in percutaneous coronary intervention: a review. Minerva Cardioangiol 2002 Oct; 50(5): 531–46

    PubMed  CAS  Google Scholar 

  12. McKay RG, Boden WE. Small peptide GP IIb/IIIa receptor inhibitors as upstream therapy in non-ST-segment elevation acute coronary syndromes: results of the PURSUIT, PRISM, PRISM-PLUS, TACTICS, and PARAGON trials. Curr Opin Cardiol 2001 Nov; 16(6): 364–9

    Article  PubMed  CAS  Google Scholar 

  13. Integrilin (eptifibatide) injection prescribing information. San Francisco (CA): COR Therapeutics Inc., 2001

  14. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-2002: summary article. Circulation 2002 Oct 1; 106(14): 1893–900

    Article  PubMed  Google Scholar 

  15. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. ESPRIT Investigators. Lancet 2000 Dec 16; 356 (9247): 2037–44

  16. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes: PURSUIT Trial Investigators. N Engl J Med 1998; 339: 436–43

    Google Scholar 

  17. Cohen DJ, Cosgrove RS, Berezin RH, et al. Cost-effectiveness of eptifibatide in patients undergoing planned coronary stenting: results from the ESPRIT trial [abstract no. 893153]. Circulation 2001 Oct 23; 104 Suppl. II (17): II–386

    Google Scholar 

  18. Data on file, Schering ACS, Kenilworth (NJ), 2003

  19. Sridhar K, Gwadry F, Kidwai B, et al. Decision analysis model of abciximab, eptifibatide or standard therapy in elective stent placement: a Canadian perspective. Value Health 2001; 4: 108

    Article  Google Scholar 

  20. PRICE Investigators. Comparative 30-day economic and clinical outcomes of platelet glycoprotein IIb/IIIa inhibitor use during elective percutaneous coronary intervention: Prairie ReoPro versus Integrilin Cost Evaluation (PRICE) trial. Am Heart J 2001 Mar; 141(3): 402–9

    Article  Google Scholar 

  21. Lage MJ, Barber BL, McCollam PL, et al. Impact of abciximab versus eptifibatide on length of hospital stay for PCI patients. Catheter Cardiovasc Interv 2001; 53(3): 296–303

    Article  PubMed  CAS  Google Scholar 

  22. McCollam PL, Luzadis R. Hospital charges in common percutaneous coronary intervention patients receiving abciximab vs eptifibatide [absract no. 189]. Pharmacotherapy 2001 Oct; 21: 1284

    Google Scholar 

  23. Rose L, Hoying M, Przytulski B. A drug use evaluation of abciximab and eptifibatide in a community hospital. PT 2000; 25(7): 360–6

    Google Scholar 

  24. Wong DH. Comparison of eptifibatide and abciximab with decision analysis. Am J Health Syst Pharm 2001 Aug 1; 58(15): 1432–6

    PubMed  CAS  Google Scholar 

  25. Schweiger MJ, Changezi HU, Naglieri-Prescod D, et al. Open-label, sequential comparison of eptifibatide with abciximab for patients undergoing percutaneous coronary intervention. Clin Ther 2003; 25: 225–34

    Article  PubMed  CAS  Google Scholar 

  26. Henderson RA, Brown R. The costs of routine eptifibatide use in acute coronary syndromes in Western Europe: an economic substudy of the PURSUIT trial. Eur Heart J Suppls 1999 Aug; 1 Suppl. N: N35–41

    Google Scholar 

  27. Brown RE, Henderson RA, Koster D, et al. Cost effectiveness of eptifibatide in acute coronary syndromes; an economic analysis of Western European patients enrolled in the PURSUIT trial. Platelet IIa/IIb in Unstable Angina: Receptor Suppression Using Integrilin Therapy. Eur Heart J 2002 Jan; 23(1): 50–8

    Article  PubMed  CAS  Google Scholar 

  28. Villar FA, Botella FA. An economic evaluation of eptifibatide [in Spanish]. Rev Esp Cardiol 2001 Feb; 54(2): 169–74

    PubMed  CAS  Google Scholar 

  29. Brown RE, Hutton J, Henderson R. Cost-effectiveness of eptifibatide in the UK based on PURSUIT trial [abstract no. PCV9]. Value Health 2001 Nov–2001 31; 4: 491

    Article  Google Scholar 

  30. Kent DM, Ruthazer R, Beshansky JR, et al. Effectiveness and cost-effectiveness of eptifibatide in individual patients with acute cardiac ischemia: the importance of risk stratification [abstract no. CV2]. Value Health 2000; 3: 295

    Article  Google Scholar 

  31. Mark DB, Harrington RA, Lincoff AM, et al. Cost-effectiveness of platelet glycoprotein IIb/IIIa inhibition with eptifibatide in patients with non-ST-elevation acute coronary syndromes. Circulation 2000 Feb 1; 101(4): 366–71

    Article  PubMed  CAS  Google Scholar 

  32. Brown R, Armstrong P. Cost effectiveness in Canada of eptifibatide treatment for acute coronary syndrome patients using PURSUIT subgroup analysis. Can J Cardiol 2003 Feb; 19(2): 161–6

    PubMed  Google Scholar 

  33. Szucs TD, Schwenkglenks M, Berger K, et al. Costs and cost-effectiveness of eptifibatide in the treatment of coronary ischemic syndromes: an analysis based on the PURSUIT study [in German]. Z Kardiol 2003 Mar; 92(3): 236–44

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The full text article in PharmacoEconomics 2003; 21 (12): 885–912 was reviewed by: J. Blankenship, Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania, USA; J.G.F. Cleland, Department of Cardiology, Castle Hill Hospital, Cottingham, England; P. Reddy, Abt Associates Clinical Trials, HERQuLES: Health Economic Research & Quality of Life Evaluation Services, Abt Associates Inc., Cambridge, Massachusetts, USA; F.A. Villar, Departamento de Economia y Empresa, Universidad de La Rioja, Logroño, Spain; P.J. Zed, CSU Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada.

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  1. Adis International Limited, 770 Township Line Road, Suite 300, Yardley, Pennsylvania, PA, 19047, USA

    Greg L. Plosker & Tim Ibbotson

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  1. Greg L. Plosker
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  2. Tim Ibbotson
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Correspondence to Greg L. Plosker.

Additional information

This Spotlight is derived from abstract and summary text of an Adis Pharmacoeconomic Drug Evaluation originally published in full in PharmacoEconomics 2003; 21 (12): 885-912. Reviewers of the original full text article are listed in the Acknowledgments section.

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Plosker, G.L., Ibbotson, T. Spotlight on Eptifibatide in Percutaneous Coronary Intervention and Acute Coronary Syndromes. Dis-Manage-Health-Outcomes 12, 207–210 (2004). https://doi.org/10.2165/00115677-200412030-00007

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