Announcements
Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.
Open Access
Review
Economic Implications of Bivalirudin in the Cardiac Catheterization Laboratory
Ameet Bakhai*, †, David J. Cohen†
Show Less
1
Harvard Clinical Research Institute, Boston, MA
2020
Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
Rev. Cardiovasc. Med. 2006, 7(S3), 35–42;
Published: 20 May 2006
Abstract
More than 1.2 million percutaneous coronary intervention (PCI) procedures are
performed each year in the United States, with average hospital costs of more than 10,000 per procedure. Despite ongoing improvements in device technology and
adjunct pharmacology, both ischemic complications (eg, periprocedural myocardial
infarction) and bleeding complications remain relatively common and are associated
with both increased costs (in the short term) and mortality (in the longer term).
Recently, the Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical
Events (REPLACE)-2 clinical trial demonstrated that the use of the direct thrombin
inhibitor, bivalirudin, with provisional glycoprotein (GP) IIb/IIIa inhibitor for selected
patients in place of a conventional anticoagulation strategy of heparin and routine use
of a GP IIb/IIIa inhibitor, resulted in comparable rates of ischemic complications and a
significant reduction in the frequency of both major and minor bleeding complications.
A prospectively designed economic analysis was performed using data from 4651 US
patients who participated in REPLACE-2. In this analysis, patients who were assigned
to the bivalirudin and provisional GP IIb/IIIa inhibitor strategy had anticoagulation
costs during PCI that were approximately 400 per patient lower than those with
heparin plus routine GP IIb/IIIa inhibition. Bivalirudin also produced corresponding
decreases in total in-hospital costs and aggregate 30-day medical care costs. These cost
savings derived both from the lower acquisition cost of the antithrombotic therapy and
the reduced rate of bleeding complications, which accounted for approximately 20%
of the cost offsets. These results suggest that for patients similar to those studied in
REPLACE-2 (ie, low to moderate risk PCI procedures), use of bivalirudin and provisional
GP IIb/IIIa inhibition compared with heparin and routine GP IIb/IIIa inhibition
can result in similar rates of ischemic complications, reduced bleeding, and substantial
cost savings to both hospitals and the healthcare system. Whether these benefits can
be extended to higher risk patient subsets including patients with non-ST elevation or
ST elevation myocardial infarction is currently under investigation.
Keywords
Percutaneous coronary intervention
Bivalirudin
Antithrombotics
Ischemia