This model-based cost-utility analysis assessed the cost-effectiveness of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitor (H-GPI) in patients undergoing primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI), and was provided for the NICE appraisal of bivalirudin use in STEMI patients undergoing PPCI.

The model evaluated incremental costs, and incremental clinical effectiveness expressed as quality-adjusted life-years (QALYs) gained.

The following findings were reported:

• The main model (clinical events until the end of year 1) predicted bivalirudin and H-GPI patients to survive 11.52 and 11.35 (undiscounted) years on average, respectively, and to accrue 6.26 and 6.17 QALYs.

• Patient lifetime costs were £267 lower in the bivalirudin strategy (£12,843 vs £13,110). Extensive sensitivity and scenario analyses confirmed these results to be robust.

• In probabilistic analysis, quality-adjusted survival was higher and costs were lower with bivalirudin in 95.0% of simulation runs.

• In 99.2%, cost-effectiveness was better than £20 000 per QALY gained.

• Results from the alternative model (Clinical events until the end of year 3 were fully consistent.

The investigators concluded that their analysis suggests that, in STEMI patients undergoing PPCI, the use of bivalirudin yields a QALY gain and is cost-effective compared to H-GPI-based anticoagulation and offers a high probability of dominance.