Cost-Effectiveness Analysis of Enoxaparin versus Unfractionated Heparin in Patients with Acute Coronary Syndrome in Poland
- Ewa OrlewskaAffiliated withDepartment of Experimental and Clinical Pharmacology, Medical University of Warsaw Email author
- , Andrzej BudajAffiliated withDepartment of Cardiology, Grochowski Hospital Postgraduate Medical School
- , Dariusz Tereszkowski-KaminskiAffiliated withUniformed Services Health Fund
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Aim and perspective: To estimate the cost effectiveness of enoxaparin versus unfractionated heparin (UFH) in patients with acute coronary syndrome (ACS) from a Polish hospital perspective. This was intended to facilitate the decision-making process in selecting the most cost-effective treatment for ACS.
Method: A decision model was used to quantify costs and effectiveness of alternative treatments. Published results from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) study were used to estimate the probability for clinical endpoints (death, myocardial infarction or recurrent angina) at 30 days. Probabilities of patients undergoing revascularisation procedures were obtained from the Global Registry of Acute Coronary Events (GRACE) which included data from 961 patients at six centres in Poland. The analysis assessed only direct medical costs, determined from actual resource consumption on a patient-specific basis (6-month observational study) and estimated using Polish data on unit costs. One- and two-way sensitivity analyses and threshold analysis were performed.
Results: At 30 days, 19.8% of patients receiving enoxaparin compared with 23.3% of those receiving UFH reached a composite endpoint consisting of death, myocardial infarction and recurrent angina (p = 0.02). The average costs (in zloty [Zl]; $US1 = Z14 [2000 values]) were 1085 per patient receiving enoxaparin compared with 1097 per patient receiving UFH. Therefore, for every 29 patients treated, not only would enoxaparin therapy avoid one event of the composite endpoint, it would also save Z1348. The threshold analysis suggests that enoxaparin would lose dominance when the cost of enoxaparin increased by 10%, the cost of monitoring UFH therapy decreased by 12%, the probability of reaching the composite endpoint in the enoxaparin arm increased to 0.22 or decreased to 0.21 in the UFH arm.
Conclusion: According to our model enoxaparin was more effective at a lower cost than UFH, therefore this treatment was shown to be dominant for patients with ACS in Poland.
- Cost-Effectiveness Analysis of Enoxaparin versus Unfractionated Heparin in Patients with Acute Coronary Syndrome in Poland
Volume 21, Issue 10 , pp 737-748
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, ul. Krakowskie Przedmiescie 26/28, Warsaw, 02-927, Poland
- 2. Department of Cardiology, Grochowski Hospital Postgraduate Medical School, Warsaw, Poland
- 3. Uniformed Services Health Fund, Warsaw, Poland