***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND In the ESSENCE trial , subcutaneous low-molecular-weight heparin ( enoxaparin ) reduced the 30-day incidence of death , myocardial infa rct ion , and recurrent angina relative to intravenous unfractionated heparin in 3171 patients with acute coronary syndrome ( unstable angina or non-Q-wave myocardial infa rct ion ) . No increase in major bleeding was seen . METHODS AND RESULTS Of the 936 ESSENCE patients r and omized in the United States , 655 had hospital billing data collected . For the remainder , hospital costs were imputed with a multivariable linear regression model ( R2=.86 ) . Physician fees were estimated from the Medicare Fee Schedule . During the initial hospitalization , major re source use was reduced for enoxaparin patients , with the largest effect seen with coronary angioplasty ( 15 % versus 20 % for heparin , P=.04 ) . At 30 days , these effects persisted , with the largest reductions seen in diagnostic catheterization ( 57 % versus 63 % for heparin , P=.04 ) and coronary angioplasty ( 18 % versus 22 % , P=.08 ) . All re source use trends seen in the US cohort were also evident in the overall ESSENCE study population . In the United States , the mean cost of a course of enoxaparin therapy was $ 155 , whereas that for heparin was $ 80 . The total medical costs ( hospital , physician , drug ) for the initial hospitalization were $ 11 857 for enoxaparin and $ 12620 for heparin , a cost advantage for the enoxaparin arm of $ 763 ( P=.18 ) . At the end of 30 days , the cumulative cost savings associated with enoxaparin was $ 1172 ( P=.04 ) . In 200 bootstrap sample s of the 30-day data , 94 % of the sample s showed a cost advantage for enoxaparin . CONCLUSIONS In patients with acute coronary syndrome , low-molecular-weight heparin ( enoxaparin ) both improves important clinical outcomes and saves money relative to therapy with st and ard unfractionated heparin BACKGROUND Despite the use of aspirin , there is still a risk of ischaemic events after percutaneous coronary intervention ( PCI ) . We aim ed to find out whether , in addition to aspirin , pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and short-term therapy for only 4 weeks after PCI . METHODS 2658 patients with non-ST-elevation acute coronary syndrome undergoing PCI in the CURE study had been r and omly assigned double-blind treatment with clopidogrel ( n=1313 ) or placebo ( n=1345 ) . Patients were pretreated with aspirin and study drug for a median of 6 days before PCI during the initial hospital admission , and for a median of 10 days overall . After PCI , most patients ( > 80 % ) in both groups received open-label thienopyridine for about 4 weeks , after which study drug was restarted for a mean of 8 months . The primary endpoint was a composite of cardiovascular death , myocardial infa rct ion , or urgent target-vessel revascularisation within 30 days of PCI . The main analysis was by intention to treat . FINDINGS There were no drop-outs . 59 ( 4.5 % ) patients in the clopidogrel group had the primary endpoint , compared with 86 ( 6.4 % ) in the placebo group ( relative risk 0.70 [ 95 % CI 0.50 - 0.97 ] , p=0.03 ) . Long-term administration of clopidogrel after PCI was associated with a lower rate of cardiovascular death , myocardial infa rct ion , or any revascularisation ( p=0.03 ) , and of cardiovascular death or myocardial infa rct ion ( p=0.047 ) . Overall ( including events before and after PCI ) there was a 31 % reduction cardiovascular death or myocardial infa rct ion ( p=0.002 ) . There was less use of glycoprotein IIb/IIIa inhibitor in the clopidogrel group ( p=0.001 ) . At follow-up , there was no significant difference in major bleeding between the groups ( p=0.64 ) . INTERPRETATION In patients with acute coronary syndrome receiving aspirin  , a strategy of clopidogrel pretreatment followed by long-term therapy is beneficial in reducing major cardiovascular events , compared with placebo OBJECTIVES The aim of this study was to determine the economic impact of several anticoagulation strategies for moderate- and high-risk non-ST-segment elevation acute coronary syndrome ( NSTE-ACS ) patients managed invasively . BACKGROUND The ACUITY ( Acute Catheterization and Urgent Intervention Triage Strategy ) trial demonstrated that bivalirudin monotherapy yields similar rates of ischemic complications and less bleeding than regimens incorporating glycoprotein IIb/IIIa receptor inhibitors ( GPI ) for moderate- and high-risk NSTE-ACS . METHODS In ACUITY , 7,851 U.S. patients were r and omized to : 1 )  heparin ( unfractionated or enoxaparin ) + GPI ; 2 ) bivalirudin + GPI ; or 3 ) bivalirudin monotherapy . Patients assigned to GPI were also r and omized to upstream GPI before catheterization or selective GPI only with percutaneous coronary intervention . Re source use data were collected prospect ively through 30-day follow-up . Costs were estimated with st and ard methods including re source -based accounting , hospital billing data , and the Medicare fee schedule . RESULTS At 30 days , ischemic events were similar for all groups . Major bleeding was reduced with bivalirudin monotherapy compared with heparin + GPI or bivalirudin + GPI ( p < 0.001 ) . Length of stay was lowest with bivalirudin monotherapy or bivalirudin + catheterization laboratory GPI ( p = 0.02 ) . Despite higher drug costs , aggregate hospital stay costs were lowest with bivalirudin monotherapy ( mean difference range : $ 184 to $ 1,081 , p < 0.001 for overall comparison ) and at 30 days ( mean difference range : $ 123 to $ 938 , p = 0.005 ) . Regression modeling demonstrated that hospital savings were primarily due to less major and minor bleeding with bivalirudin ( $ 8,658/event and $ 2,282/event , respectively ) . CONCLUSIONS Among U.S. patients in the ACUITY trial , bivalirudin monotherapy compared with heparin + GPI result ed in similar protection from ischemic events , reduced bleeding , and shorter length of stay . Despite higher drug costs , aggregate hospital and 30-day costs were lowest with bivalirudin monotherapy . Thus bivalirudin monotherapy seems to be an economically attractive alternative to heparin + GPI for patients with moderate- and high-risk NSTE-ACS . ( Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ ACS ] ; NCT00093158 ) Background The CURE study demonstrated that clopidogrel prevents a range of ischaemic cardiovascular events in patients with Acute Coronary Syndromes ( unstable angina or non-ST-segment elevation MI ) . Design We undertook an economic analysis of the use of clopidogrel in the UK , USA , Sweden , France and Canada based on the CURE study . Methods The costs of hospitalization , study drug and other medications were calculated , based on re source utilization for all patients in CURE .  Unit costs were obtained for all re source items for each country , and are reported in local currencies in 2001 prices . Results While hospitalization costs were lower in the clopidogrel group , when the acquisition cost of clopidogrel for 9 months is included , the average cost per patient is higher in the clopidogrel group than the placebo group in all countries [ difference in costs ( with 95 % CI ) UK £ 208 ( 119 , 297 ) , US$ 451 ( 58 , 845 ) , SKr 2571 ( 728 , 4412 ) , Fr ∊325 ( 85 , 565 ) , C$ 161 ( −185 , 506 ) ] . The absolute reduction in the number of total primary events was 2.0 % , result ing in an incremental cost-effectiveness ratio ( ICER ) of £ 10,366 in the UK , $ 22,484 in the USA , SKr 127,951 in Sweden , ∊16,186 in France , and C$ 7973 in Canada per primary event avoided with clopidogrel . Conclusions Clopidogrel in CURE reduced hospitalization costs but the acquisition cost of clopidogrel creates an overall increase in direct health care costs over 9 months . Nevertheless , the cost-effectiveness is in a range comparable to other therapies currently utilized for acute coronary syndromes BACKGROUND In the PURSUIT trial , eptifibatide significantly reduced the 30-day incidence of death and myocardial infa rct ion relative to placebo in 9461 patients with an acute coronary syndrome ( unstable angina or non-Q-wave myocardial infa rct ion ) . METHODS AND RESULTS We conducted a 2-part prospect i ve economic sub study of the 3522 US patients enrolled in PURSUIT : ( 1 ) an empirical intention-to-treat comparison of medical costs ( hospital plus physician ) up to 6 months after hospitalization and ( 2 ) a lifetime cost-effectiveness analysis . The base-case cost-effectiveness ratio was expressed as the 1996 US dollars required to add 1 life-year with eptifibatide therapy . The 2 treatment arms had equivalent re source consumption and medical costs ( exclusive of the cost of the eptifibatide regimen ) during the index ( enrollment ) hospitalization ( P=0.78 ) and up to 6 months afterward ( P=0.60 ) . The average wholesale price of the eptifibatide regimen was $ 1217 , but a typical hospital discounted price was $ 1014 . The estimated life expectancy from r and omization in the US patients was 15.96 years for eptifibatide and 15.85 years for placebo , an incremental difference of 0.111 . The incremental cost-effectiveness ratio for eptifibatide therapy in US PURSUIT patients was $ 16 491 per year of life saved . This result was robust through a wide range of sensitivity analyses . The cost-utility ratio for eptifibatide ( using time trade-off defined utilities ) was $ 19 693 per added quality -adjusted life-year . CONCLUSIONS Based on the results observed in the US PURSUIT patients , the routine addition of eptifibatide to st and ard care for non-ST-elevation acute coronary syndrome patients is economically attractive by conventional st and ards AIMS To assess the direct medical costs and cost effectiveness of routine eptifibatide use amongst patients with unstable angina and myocardial infa rct ion without persistent ST-segment elevation in the Western European subgroup of the PURSUIT trial . METHODS AND RESULTS Health care re sources were collected for the Western European PURSUIT trial patients ( n=3697 ) . Unit costs for major re sources were developed within six countries using a consistent bottom-up methodology . Re source consumption from the Western European population was used to calculate the average direct medical costs per patient in the eptifibatide and placebo arms of the trial . Eptifibatide was estimated to cost 524 Euros per treatment . Long-term survival estimated from the 6-month trial survival data and combined with the cost data was used to calculate cost-effectiveness ratios . Additionally , cost per death and non-fatal myocardial infa rct ion at 30 days was calculated . Sensitivity analyses were conducted on the discount rate and re source consumption . Cost-effectiveness ratios ranged from 9603 Euros to 18 115 Euros per year of life saved with 3 % discount . Using re source consumption based on countries with low coronary arteriography rates , the cost per year of life saved was between 3329 Euros and 10 079 Euros . Using re source consumption based on high coronary arteriography rate countries , the cost per year of life saved was between 17 089 Euros and 24 099 Euros . Assuming no difference in treatment costs except for the addition of eptifibatide , the incremental cost per year of life saved was 23 818 Euros . CONCLUSIONS Routine eptifibatide use was associated with a reduction in the combined end-point of death and myocardial infa rct ion at 30 days , which was sustained at 6 months . Long-term projections indicate a modest increase in survival in eptifibatide patients . These data translate into cost-effectiveness ratios that compare favourably with other new technologies that are currently in use BACKGROUND Dual-antiplatelet therapy with aspirin and a thienopyridine is a cornerstone of treatment to prevent thrombotic complications of acute coronary syndromes and percutaneous coronary intervention . METHODS To compare prasugrel , a new th 
    Output:
    
Conclusions Evidence from the present systematic review suggests that the majority of the available treatments represent either cost-saving or cost-effective options for NSTE-ACS patients .