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Abciximab provides cost-effective survival advantage in high-volume interventional practice

AMERICAN HEART JOURNAL 2000年第4期140卷 603-610页

作者： Kereiakes, DJ Obenchain, RL Barber, BL Smith, A McDonald, M Broderick, TM Runyon, JP Shimshak, TM Schneider, JF Hattemer, CR Roth, EM Whang, DD Cocks, D Abbottsmith, CW Carl & Edyth Lindner Ctr Res & Educ Cincinnati OH 45219 USA Eli Lilly & Co Indianapolis IN 46285 USA Christ Hosp Indianapolis IN USA Ohio Heart Hlth Ctr Indianapolis IN USA

Background Placebo-controlled randomized trials of platelet glycoprotein (GP) IIb/IIIa blockade during percutaneous coronary intervention have demonstrated efficacy of these agents for reducing the risk of periprocedural ischemic events. However, cost-effectiveness of this adjunctive pharmacotherapy has been scrutinized. Extrapolation of cost-efficacy observations from clinical trials to "real world" interventional practice is problematic. Methods consecutive percutaneous coronary interventions (n = 1472) performed by Ohio Heart Health Center operators at The Christ Hospital, Cincinnati, Ohio, in 1997 were analyzed for procedural and long-term (6-month) outcomes and charges. Observations on cost and efficacy (survival) were adjusted for nonrandomized abciximab allocation by means of "propensity scoring" methods. Results Abciximab therapy was associated with a survival advantage to 6 months after percutaneous coronary intervention. The average reduction in mortality rate at b months was 3.4% (unadjusted) and 4.9% when adjusted for nonrandomization. The average charge increment to 6 months was $1512 (unadjusted) and $950 when adjusted for nonrandomization. Patients deriving the greatest reduction in mortality rates also had a reduction in total cardiovascular charges to b months. Distinguishing demographics of this population included multivessel coronary intervention, coronary stent deploy ment, intervention within 1 week of myocardial infarction, and lower left ventricular election fraction. The average cost per lire-year gained in this study was $2875 for all patients (unadjusted) and $1243 when adjusted for nonrandomization. Conclusions Abciximab provides a cost-effective survivor advantage in high-volume interventional practice that compares favorably with currently accepted standards. Clinical and procedural demographics associated with increased cost-effectiveness included multivessel coronary intervention, stent deployment, recent (<1 week) myocardial infarcti

关键词：抗体单克隆/经济学抗体单克隆/治疗应用冠心病/经济学冠心病/死亡率冠心病/治疗费用效益分析免疫球蛋白Fab片段/经济学免疫球蛋白Fab片段/治疗应用俄亥俄/流行病学血小板聚集抑制剂/经济学血小板聚集抑制剂/治疗应用血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂预后存活率/发展趋势女(雌)性人类男(雄)性中年人

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Monoclonal antibodies and the FACS: complementary tools for immunobiology and medicine

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IMMUNOLOGY TODAY 2000年第8期21卷 383-390页

作者： Herzenberg, LA De Rosa, SC Herzenberg, LA Stanford Univ Sch Med Dept Genet Stanford CA 94305 USA

The histories of monoclonal antibodies and the fluoroescence activated cell sorter (FACS) are as closely intertwined as their current uses in biology and medicine. Here, Leonore Herzenberg, Stephen De Rosa and Leonard Herzenberg recount the meeting and the mating of these two technologies, whose offspring now populate clinical and research laboratories throughout the world.

关键词：抗体单克隆/诊断应用抗体单克隆/经济学抗体单克隆/免疫学抗原 CD/免疫学细胞分离细胞因子类/分析流式细胞术/经济学流式细胞术/方法荧光染料指示剂和试剂激光 T淋巴细胞亚群/免疫学动物人类

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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

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AMERICAN HEART JOURNAL 2001年第3期141卷 402-409页

作者： Lam, W Gill, JB Trask, RV Mallavarapu, CT Rocha-Singh, KJ Mikell, FL Mishkel, GJ Mayer, SA Aguirre, FV Yakel, D Steen, MS Kacich, RL Shelton, ME Chaitman, BR Stocke, K Katholi, R Pianfetti, L Tatum, M McMillan, S Ligon, RW Holloway, C Cohen, DJ Staten, N Laswell, K Sullivan, P Rothert, T Page, L Brooks, M Entwistle, K Drew, D So Illinois Univ Sch Med Prairie Cardiovasc Consultants Ltd Prairie Educ & Res CooperatSpringfield Clin Card Springfield IL 62794 USA Beth Israel Deaconess Med Ctr Boston MA 02215 USA St Louis Univ Hlth Sci Ctr St Louis MO 63103 USA

Objectives This studs examined the economics, pharmacodynamics, and clinical outcomes among patients randomly assigned to receive either abciximab (ReoPro, Centocor, Inc, Malvern, Pa, and Eli Lilly & Company, Indianapolis, Ind) or eptifibatide (Integrilin, COR Therapeutics, inc, South San Francisco, Calif, and Key Pharmaceuticals, Inc, Kenilworth, NJ) therapy during elective percutaneous coronary intervention (PCI). Background Clinical and safety outcomes after elective PCI with a high-dose eptifibatide treatment strategy have not previously been systematically evaluated. In addition, comparative economic and pharmacodynamic studies of platelet glycoprotein (GP) IIb/IIIa receptor antagonists during PCI are sparse. Methods This randomized, double-blind study assessed the 30-day economic and clinical outcomes of 320 consecutive patients undergoing elective coronary balloon angioplasty or stent implantation who were randomly assigned to receive adjunct abciximab (n = 163) or eptifibatide (n = 157) therapy. The primary study end point was total in-hospital costs based on an intention-to-treat analysis. A secondary end point included 30-day total hospital costs. A platelet aggregometry sub-study was performed on 155 patients (abciximab: n = 74 and eptifibatide: n = 81) with use of the Ultegra Rapid Platelet Function Assay. Results Baseline demographic, angiographic, and procedural variables were similar between the two treatment groups. The median and interquartile ranges of total in-hospital costs were $8268 ($6505, $9958) and $7207 ($5659, $9307), respectively, between the abciximab- and eptifibatide-treated patients (P = .009). Median total costs at 30 days were $8336 ($6505, $10,126) and $7207 ($5659, $9431), respectively, between the abciximab- and eptifibatide-treated groups (P = .009). The composite secondary clinical end points (death/nonfatal myocardial infarction/urgent revascularization) occurred in 4.9% versus 5.1% of patients, respectively, by hospital disch

关键词：抗体单克隆/经济学抗体单克隆/治疗应用冠心病/药物疗法冠心病/治疗双盲法医院费用伊利诺伊免疫球蛋白Fab片段/经济学免疫球蛋白Fab片段/治疗应用肽类/经济学肽类/治疗应用血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂支架治疗结果女(雌)性人类男(雄)性中年人

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Glycoprotein IIb-IIIa inhibition with abciximab and postprocedural risk assessment: Lessons from the evaluation of platelet IIb/IIIa inhibitor for stenting trial and implication for ad hoc use of glycoprotein IIb-IIIa antagonists

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AMERICAN HEART JOURNAL 2002年第4期143卷 594-601页

作者： Mazur, W Kaluza, GL Sapp, S Balog, C Topol, EJ Mark, DB Ellis, SG Kereiakes, DJ Lincoff, AM Kleiman, NS Baylor Coll Med Houston TX 77030 USA Methodist Hosp Houston TX 77030 USA Cleveland Clin Fdn Cleveland OH 44195 USA Lindner Ctr Cardiovasc Res Cincinnati OH USA Duke Clin Res Org Durham NC USA

Background Angiographic features of vessels in which stents have been deployed can be used to predict the risk of postprocedural ischemic events. The purpose of this study was to compare the effects of abciximab in patients with and without high-risk postprocedure features. Methods and Results Protocol-mandated stent implantation was performed in 1586 patients in the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting trial, 783 of whom received abciximab, and was successful in 97% of the patients. High-risk features were defined as the presence of Thrombolysis In Myocardial Infarction (TIMI) flow < 3, presence of thrombus or major dissection, or residual stenosis > 10%. The primary endpoint was a composite of death, myocardial infarction, and urgent target vessel revascularization at 30 days. High-risk features were present in 21% of the patients. In patients without high-risk features after stent placement, abciximab reduced the primary endpoint from 9.0% to 3.9% (P < .001) compared with 16.2% to 8.6% (P = .046) in patients in whom high-risk features were present. There was no statistical evidence of interaction between abciximab treatment and the presence or absence of high-risk features. Conclusion Glycoprotein IIb-IIIa antagonism with abciximab is equally effective in prevention of a composite of ischemic events in patients with and without high-risk features after stent placement. However, patients in whom high-risk features are present after stent placement are at increased risk of ischemic cardiac events even with abciximab treatment.

关键词：抗体单克隆/经济学抗体单克隆/治疗应用冠心病/经济学冠心病/死亡率冠心病/治疗医院费用免疫球蛋白Fab片段/经济学免疫球蛋白Fab片段/治疗应用心肌梗死/病因学血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂危险性评估支架/经济学女(雌)性人类男(雄)性中年人

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Herceptin (trastuzamab) in advanced breast cancer

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CANCER TREATMENT REVIEWS 2000年第4期26卷 287-290页

作者： Stebbing, J Copson, E O'Reilly, S Royal Marsden Hosp London SW3 6JJ England Waterford Reg Hosp Waterford Ireland

Herceptin (trastuzamab, Genentech, San Francisco, CA, USA) prolongs survival in metastatic breast cancer patients whose tumours overexpress the HER2/neu protein. Compared with chemotherapy alone, patients receiving chemotherapy and Herceptin have a significantly longer time to progression, a higher response rate and a longer duration of response. These effects are most marked in first-line treatment of metastatic disease. The addition of Herceptin is associated with few additional side-effects, apart from cardiac toxicity in patients concurrently receiving anthracyclines. As such, it seems reasonable for Herceptin to become considered as one of the routine treatment options in metastatic breast cancer: It would therefore be appropriate for HER2 status testing to be incorporated into the assessment of all patients with metastatic disease. The use of this medication will be limited by its cost. Furthermore, data are lacking on appropriate treatments durations in responders. (C) 2000 Harcourt Publishers Ltd.

关键词：抗体单克隆/经济学抗体单克隆/治疗应用抗肿瘤药/经济学抗肿瘤药/治疗应用乳腺肿瘤/免疫学乳腺肿瘤/继发性乳腺肿瘤/治疗免疫疗法原癌基因蛋白质类受体 erbB-2/免疫学女(雌)性人类

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Comparison of eptifibatide and abciximab with decision analysis

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2001年第15期58卷 1432-1436页

作者： Wong, DH Methodist Hosp So Calif Dept Pharm Serv Arcadia CA 91007 USA

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Abciximab: Cost-effective survival advantage in clinical trials and clinical practice

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AMERICAN HEART JOURNAL 2000年第6期140卷 S148-S153页

作者： Young, JJ Kereiakes, DJ Carl & Edyth Lindner Ctr Res & Educ Cincinnati OH 45219 USA Ohio Heart Hlth Ctr Cincinnati OH USA

Adjunctive blockade of the platelet glycoprotein (GP) IIb/IIIa receptor during either percutaneous coronary intervention (PCI) or for patients who present with non-ST segment elevation acute coronary syndromes has demonstrated efficacy in reducing platelet-mediated adverse cardiovascular ischemic events. The three currently available agents (abciximab, eptifibatide, tirofiban) differ markedly in pharmacodynamic and pharmacokinetic profiles, receptor affinity, and cost. Although pharmacoeconomic substudies are available from placebo-controlled randomized trials of platelet GPIIb/IIIa blockade during PCI, "real-world" cost-effectiveness data from high-volume practice are lacking. Therefore, in-hospital and late (6-month) clinical:outcomes and cumulative cost/charge data were analyzed on 1472 consecutive PCI procedures (70% received abciximab) performed by high-volume operators at a single institution.(1) Data were adjusted for lack of randomized treatment allocation with the use of a propensity scoring technique. Adjunctive abciximab therapy for PCI was associated with a significant (3.4%) reduction in mortality to 6 months. Based on the economic cost-effectiveness concept of cost per life year gained relative to standard therapy,(2,3) abciximab provided a cost-effective survival advantage in high-volume interventional practice that compares very favorably with currently accepted standards. Clinical and procedural demographics associated with;increased cost-effectiveness include multivessel coronary intervention, stent deployment, recent (<1 week) myocardial infarction (MI), and impaired left-ventricular (IV) function.

关键词：抗体单克隆/经济学抗体单克隆/治疗应用费用效益分析免疫球蛋白Fab片段/经济学免疫球蛋白Fab片段/治疗应用心肌缺血/药物疗法心肌缺血/经济学心肌缺血/死亡率血小板聚集抑制剂/经济学血小板聚集抑制剂/治疗应用血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂随机对照试验(主题)/经济学存活率分析存活率美国/流行病学人类

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The role of daclizumab in balancing resources for inpatient and outpatient transplant services

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Progress in Transplantation 2000年第1期10卷 21-24页

作者： Korsun, A. Vincenti, F. Ruck, D. Whitelaw, N. Ladoulis, C. Whitelaw, G. InnoVision Communications Aliso Viejo CA 92656 101 Columbia United States

Transplant professionals have the dual responsibility of achieving acceptable clinical outcomes and controlling costs. One approach transplant centers have used to control transplant-related costs has been to decrease patients' length of stay, and thus it has decreased significantly in the last 6 years. This reduction in resource consumption has been accomplished by increased efficiency in providing transplantation services, expanding the number of outpatient services available, and integrating new technologies. Future cost containment measures by payers, especially Medicare, will continue to require that transplant centers manage resources and meet financial objectives while achieving acceptable clinical outcomes. Daclizumab, a new immunosuppressive drug, is used as an example in this article, which assesses its value in helping meet resource management and financial goals.

关键词：抗体单克隆/经济学抗体单克隆/治疗应用费用控制卫生资源/经济学卫生资源/利用免疫球蛋白G/经济学免疫球蛋白G/治疗应用免疫抑制剂/经济学免疫抑制剂/治疗应用肾移植/经济学肾移植/免疫学住院时间/经济学住院时间/统计学和数值数据 Medicare 偿还途径/经济学偿还途径/统计学和数值数据美国人类

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Alemtuzumab.

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American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2001年第24期58卷 2372-2373页

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