TCT Feature: Bivalirudin's potential to save time, money explored
WASHINGTON, D.C.—Use of bivalirudin as adjunctive therapy in PCI patients decreased incidence of bleeding and also reduced length of stay and costs, according to research presented during a poster presentation Sept. 22 at the 2010 Transcatheter Cardiovascular Therapeutics (TCT) annual conference.

Neeraj Bajaj, told Cardiovascular Business News, that the observational study that looked at 452,044 PCI admissions between 2004 and 2008 to assess the economic impact of bivalirudin or heparin use, with or without a glycoprotein IIb/IIIa inhibitor (GPI).

The study reported observational data from the Premier Perspective database on patients in four patient groups: bivalirudin only; bivalirudin plus GPI, heparin-alone; or heparin plus GPI.

Post PCI, the researchers found that mean length of stay for bivalirudin, bivalirudin plus GPI, heparin and heparin plus GPI were 0.8 days, 1.4 days, 1.5 days and 1.6 days, respectively. Mean hospital costs for the aforementioned study arms were reported to be $13,927, $17,095, $15,943, and $16,710, respectively.

“After adjusting for certain covariates, use of bivalirudin monotherapy compared to heparin plus glycoprotein inhibitor, reduced length of stay by a quarter of a day, and cost was also significantly less,” said Neeraj. However, results showed that length of stay post PCI remained unchanged with use of heparin monotherapy and for bivalirudin plus GPI.

“These findings were also corroborated in patients with and without bleeding complications,” said Bajaj.

“Previous randomized controlled data has demonstrated that bivalirudin used for PCI as adjunctive pharmacotherapy reduces bleeding complications. Analysis of this same randomized controlled data has shown that it has reduced cost. Our data confirm that in a large, real-world registry dataset of PCI patients, bivalirudin monotherapy reduces cost and length-of-stay,” he said.

Results showed that compared with heparin plus GPI, bivalirudin and heparin stand-alone therapy reduced hospital costs by $1,116 and $650, respectively. In contrast, bivalirudin plus GPI increased hospital costs by $1,320.

For patients with bleeding complications, hospital costs decreased only with use of bivalirudin therapy, but increased with use of bivalirudin plus GPI. For patients administered heparin and who had bleeding complications, costs remained essentially unchanged.

“Bivalirudin and heparin both yielded cost savings in patients without bleeding complications, while bivalirudin plus GPI was linked to higher costs in these patients,” the researchers wrote.

While Bajaj noted that heparin therapy has “essentially negligible cost,” he said it is hard to understand “exactly what aspect of bivalirudin reduces the cost and length of stay.”

He said, “We originally supposed that these lower costs are associated with the reduction of bleeding events that lead to a shorter length of stay. But further investigation is needed to investigate this, as our data show that cost is lower in patients receiving bivalirudin monotherapy with and without bleeding complications.”