Vicost Analysis With Bivalirudin

Bivalirudin is the only anticoagulant associated with lower rates of both ischemic and bleeding complications compared to heparin in studies of PCI. These complications are associated with increased morbidity and mortality, as well as higher costs and—as reported by Lauer (2000) and Compton (2002)—have a substantial impact on the cost of PCI, making bivalirudin financially more attractive. Bivali-rudin may also be associated with a shorter hospital stay, use of fewer closure devices, lower incidence of hematoma formation, earlier sheath removal, and more selective use of the GPIIb/IIIa inhibitors.

A recent economic evaluation of bivalirudin was reported on the 4651 PCI patients enrolled in the REPLACE-2 trial. In-hospital and 30-day costs were reduced in the bivalirudin group. In addition, regression modeling demonstrated that the hospital savings were not only due to the costs savings of the anticoagulants themselves, but primarily due to the reduction in bleeding and throm-bocytopenia that resulted from the use of bivalirudin (Cohen et al., 2004). A more recent prospective economic analysis in the ACUITY trial involving 7851 patients found a shorter overall length of stay (Pinto et al., 2006) and a significant reduction in overall initial hospital costs (personal communications from The Medicine Company), although publication of the hospital- and 30-day costs are pending.

Dang and colleagues (2006) recently reviewed data on 42 hospitalized patients who were treated with bivalirudin, argatroban, or lepirudin for HIT or presumed HIT. Based on average treatment and wholesale price, bivalirudin cost less per day than the other two agents. Potential savings are also possible in patients treated for HIT by reducing its devastating and costly thrombotic complications.

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