Anticoagulant Angiomax proves itself cost-effective, as well as clinically viable. Image Source: ISMAAP

Despite higher drug costs, aggregate hospital and 30-day costs were lowest with bivalirudin monotherapy, making the anticoagulant an economically attractive alternative to heparin plus glycoprotein IIb/IIIa receptor inhibitors (GPI) for patients with moderate- and high-risk acute coronary syndrome, according to a prospective analysis of the ACUITY trial in the Nov. 25 issue of the Journal of the American College of Cardiology.

The ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, which randomized 7,851 U.S. patients, demonstrated that bivalirudin monotherapy yields similar rates of ischemic complications and less bleeding than regimens incorporating GPI for moderate- and high-risk non–ST-segment elevation-acute coronary syndrome (NSTE-ACS).

Duane S. Pinto, MD, from the division of cardiology at Beth Israel Deaconess Medical Center in Boston, and colleagues estimated costs with standard methods, including resource-based accounting, hospital billing data and the Medicare fee schedule.

At 30 days, the researchers found that ischemic events were similar for all groups. However, major bleeding was reduced with bivalirudin monotherapy compared with heparin plus GPI or bivalirudin plus GPI. Length of stay was lowest with bivalirudin monotherapy or bivalirudin plus catheterization laboratory GPI, the authors wrote.

Despite higher drug costs, Pinto and colleagues found that aggregate hospital stay costs were lowest with bivalirudin monotherapy (mean difference range: $184 to $1,081 for overall comparison) and at 30 days (mean difference range: $123 to $938). Regression modeling demonstrated that hospital savings were primarily due to less major and minor bleeding with bivalirudin ($8,658 per event and $2,282 per event, respectively), the authors noted.

“The cost savings seen in this new analysis provide further support for the use of Angiomax monotherapy as the preferred antithrombotic strategy for patients with ACS undergoing PCI,” said Pinto. “The data show Angiomax reduces major and minor bleeding, which leads to improved patient outcomes, as well as shorter length of stay, an increasingly important consideration in clinical cardiovascular care.”