Document Detail


Cost effectiveness of fondaparinux in non-ST-elevation acute coronary syndrome.
MedLine Citation:
PMID:  19663529     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jaime Latour-Perez; Eva de-Miguel-Balsa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  PharmacoEconomics     Volume:  27     ISSN:  1170-7690     ISO Abbreviation:  Pharmacoeconomics     Publication Date:  2009  
Date Detail:
Created Date:  2009-08-11     Completed Date:  2009-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9212404     Medline TA:  Pharmacoeconomics     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  585-95     Citation Subset:  T    
Affiliation:
Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Spain. jlatour@coma.es
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / 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:
0/Anticoagulants; 0/Polysaccharides; 0/fondaparinux

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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