| Cost effectiveness of fondaparinux in non-ST-elevation acute coronary syndrome. | |
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MedLine Citation:
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PMID: 19663529 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Fondaparinux has been shown to reduce the risk of major bleeding and 30-day mortality compared with enoxaparin, in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). However, its cost effectiveness is not well known. OBJECTIVE: To evaluate the effectiveness and economic attractiveness of fondaparinux relative to enoxaparin in patients with NSTE-ACS treated with triple antiplatelet therapy and early (non-urgent) invasive strategy. METHODS: The decision model compares two alternative strategies: subcutaneous (SC) enoxaparin (1 mg/kg 12 hourly) versus SC fondaparinux (2.5 mg/day) in NSTE-ACS patients pre-treated with triple antiplatelet therapy and early revascularization. Cost-effectiveness and cost-utility analyses were performed from a healthcare perspective, based on a Markov model with a time horizon of the patient lifespan. Univariate sensitivity analysis and probabilistic (Monte Carlo) microsimulation analysis were performed. RESULTS: In the base-case analysis (65 years, Thrombolysis In Myocardial Infarction [TIMI] score 4), the use of fondaparinux was associated with a significant reduction in major bleeding, a slight reduction in adverse cardiac events, and minor improvements in survival and QALYs, together with a small reduction in costs. The dominance of fondaparinux over enoxaparin remained unchanged in the univariate sensitivity analyses. According to Monte Carlo simulation, fondaparinux was cost saving in 99.9% of cases. CONCLUSION: Compared with enoxaparin, the use of fondaparinux in patients with NSTE-ACS managed with an early invasive strategy appears to be cost effective, even in patients with a low risk of bleeding. |
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Authors:
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Jaime Latour-Perez; Eva de-Miguel-Balsa |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: PharmacoEconomics Volume: 27 ISSN: 1170-7690 ISO Abbreviation: Pharmacoeconomics Publication Date: 2009 |
Date Detail:
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Created Date: 2009-08-11 Completed Date: 2009-10-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9212404 Medline TA: Pharmacoeconomics Country: New Zealand |
Other Details:
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Languages: eng Pagination: 585-95 Citation Subset: T |
Affiliation:
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Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Spain. jlatour@coma.es |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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drug therapy*,
economics Anticoagulants / economics*, therapeutic use* Cost-Benefit Analysis Data Interpretation, Statistical Decision Support Techniques Electrocardiography Humans Markov Chains Polysaccharides / economics*, therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Polysaccharides; 0/fondaparinux |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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