Document Detail


Enoxaparin is a cost-effective adjunct to fibrinolytic therapy for ST-elevation myocardial infarction in contemporary practice.
MedLine Citation:
PMID:  20422473     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: In patients receiving fibrinolytic therapy for ST-elevation myocardial infarction (STEMI), adjunct treatment with enoxaparin has been shown to provide superior net clinical benefit compared with unfractionated heparin (UFH) in the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment - Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 study. The objective of this study was to compare the cost effectiveness of enoxaparin and UFH strategies. METHODS: A cost-utility analysis was conducted using a two-stage model: (1) A 30-day decision tree analytical model for the acute treatment phase, and (2) a lifetime Markov model (from 30 days post-STEMI until death) populated using patient survival data. RESULTS: Assuming treatment continuation for 7 days, the mean day 1-30 incremental cost associated with enoxaparin was pound 49 per patient, and mean lifetime incremental cost was pound 592 per patient ( pound 91,091 vs. pound 90,499, respectively). Given an additional 0.048 life years gained per patient with enoxaparin, the cost per life year saved was pound 12,353, and given an additional 0.038 quality-adjusted life years (QALY) per patient with enoxaparin, the cost per QALY was pound 15,413. In an alternative scenario, reflecting contemporary practice assuming early treatment discontinuation at 48 hours, for example following urgent revascularization, the incremental cost per QALY was pound 13,556. CONCLUSION: The use of an enoxaparin versus UFH strategy in patients receiving fibrinolytic therapy for STEMI, whether continued for 7 days or discontinued early, for example following urgent revascularization, is cost effective at a pound 20,000 willingness-to-pay threshold.
Authors:
Ian Menown; Gilles Montalescot; Nikhal Pal; Carrie Fidler; Michelle Orme; Samantha Gillard
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-23
Journal Detail:
Title:  Advances in therapy     Volume:  27     ISSN:  1865-8652     ISO Abbreviation:  Adv Ther     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-05-13     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8611864     Medline TA:  Adv Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  181-91     Citation Subset:  T    
Affiliation:
Craigavon Cardiac Centre, Craigavon, Northern Ireland, UK. ian.menown@southerntrust.hscni.net
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MeSH Terms
Descriptor/Qualifier:
Cost-Benefit Analysis
Decision Trees
Electrocardiography
Enoxaparin / economics*,  therapeutic use
Fibrinolytic Agents / economics*,  therapeutic use
Heparin / economics*,  therapeutic use
Humans
Markov Chains
Myocardial Infarction / drug therapy*
Quality-Adjusted Life Years
Chemical
Reg. No./Substance:
0/Enoxaparin; 0/Fibrinolytic Agents; 9005-49-6/Heparin

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


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