National economic impact of tirofiban for unstable angina and myocardial infarction without ST elevation; example from the United Kingdom

Background: Acute coronary syndromes without ST elevation are a major health and economic burden. Treatments such as glycoprotein IIb/IIIa antagonists like tirofiban reduce the risk of complications but the cost impact of these agents including cost offsets of avoiding complications are needed particularly in Europe. Methods: We used treatment patterns from the Prospective Registry of Acute Ischemic Syndromes in the UK, risk reductions derived from the PRISM-PLUS trial and cost estimates from the CHKS database to estimate the impact of tirofiban on PRAIS-UK patients with and without complications and subgroups at higher risk of complications. These subgroups (and proportions) were patients: (1) aged 60 or over with abnormal electrocardiograms (58%), (2) with ST depression or bundle branch block on admission (30%) and (3) with ST depression, bundle branch block or MI on admission (37%). Results: Total cost of care in the UK at 6 months for the estimated 87 339 acute coronary syndromes admissions annually was £213 million, which would increase by £33 million (15.7%) if tirofiban were given to all patients, avoiding 2422 complications at a mean cost per event avoided of £13 388. Among the subgroups, the mean cost per event avoided ranges from £10 856 for subgroup 1 to £5953 for subgroup 3. Treating the latter subgroup, would avoid 1977 events at a cost of £12 million (5.5%). Conclusion: The use of tirofiban in the UK to treat acute coronary syndromes patients without ST elevation provides an important therapeutic advantage at modest proportional increase in cost, particularly if targeted to higher risk subgroups as recommended in the European guidelines.