The ruling should increase this drug class's use in the UK. NICE also suggests a study should be carried out into cost/effectiveness ratios for the different drugs in this class. This may well be good news for Merck, since the company's Aggrastat is cheaper than its competitors and is expected to show equivalence in these trials.
The National Institute for Clinical Excellence (NICE) in the UK has just ruled that the Glycoprotein IIb/IIIa Inhibitors class of powerful anti-platelet drugs administered intravenously to reduce blood clotting, should be given to high risk patients who have either a minor heart attack, unstable angina or who are undergoing a balloon angioplasty (PTCA).
Of the 115,000 patients admitted to hospital in England and Wales each year with acute coronary syndromes (ACS), it is estimated that approximately one third are classified as being at 'high risk', and eligible for GPIIb/IIIa treatment. Furthermore, the NICE report reveals that in 1998, 437 PTCAs were performed per million people, equating to approximately 20,000 PTCAs in England and Wales each year.
Based on current usage estimates, the decision is expected to cost the NHS an additional GBP14 million ($19.6 million) a year. NICE estimates that on average, treatment with Lilly's ReoPro (abciximab) as an adjunct to PTCA costs GBP840 per patient. The figures are GBP455 for Schering Plough's Integrilin (eptifibatide), and GBP440 for Merck's Aggrastat (tirofiban).
Whilst the original agent in this class, Lilly's ReoPro, was first launched in 1995 in the US, there has been a relatively low usage of GPIIb/IIIa inhibitors in the UK, due to their high cost and a lack of catheterisation laboratory facilities in which to conduct PTCA procedures. This decision should result in a more rapid uptake of these drugs, which is good news for the manufacturers.
However, it could prove particularly good news for Merck. NICE concludes its report by recommending that further research into the relative cost effectiveness of the different GPIIb/IIIa inhibitors, both as a medical treatment for UA and as an adjuvant therapy for PTCA, is required. So the main winner should be Merck's Aggrastat, which is expected to show equivalence to the more expensive ReoPro in a forthcoming trial. If positive, the results will be aggressively marketed.