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