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Minimizing costs for treating deep vein thrombosis: the role for fondaparinux

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Abstract

Background

Deep vein thrombosis (DVT) remains a major burden and fondaparinux represents a new option for DVT therapy. We sought to determine if fondaparinux offered financial advantages over low-molecular weight heparin since it is given as a fixed dose over a wide range of patient weights rather then dosed directly on weight and because fondaparinux is not associated with heparin-induced thrombocytopenia (HIT).

Methods

We conducted a cost-minimization analysis comparing fondaparinux to enoxaparin for acute anticoagulation in DVT. We modeled a cohort of 1,000 hypothetical subjects and drew estimates for model inputs from the published literature. We completed multiple sensitivity analyses to asses the significance of our assumptions and used Monte Carlo simulation to estimate the 95% confidence intervals (CIs) around our estimation of the cost differential for the two agents.

Results

In the base case, total disease management costs per patient with fondaparinux are $US 472 compared to $769 with enoxaparin. The 95% CI around this difference ranges from $US 48 to $US 401. The model was mildly sensitive to the pharmacy acquisition costs of fondaparinux and enoxaparin which was the major driver of overall costs. Neither the rates of nor costs associated with DVT recurrence, major bleeding, nor HIT substantially affected our observations. Breakeven analysis indicated our findings to be robust over a wide range of likely clinical scenarios.

Conclusions

From the perspective of a healthcare system, fondaparinux use offers an attractive economic alternative to other agents for initial DVT therapy. Expanded reliance on fondaparinux could potentially result in savings.

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Authors and Affiliations

  1. Pulmonary & Critical Care Medicine, Washington Hospital Center, 110 Irving St., NW, Washington, DC, 20010, USA

    Andrew F. Shorr

  2. Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA

    William L. Jackson

  3. Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA

    Lisa K. Moores

  4. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, USA

    Theodore E. Warkentin

Authors
  1. Andrew F. Shorr
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  2. William L. Jackson
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  3. Lisa K. Moores
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  4. Theodore E. Warkentin
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Corresponding author

Correspondence to Andrew F. Shorr.

Additional information

Funding: Supported as an Investigator Initiated Study from Glaxo Smith Kline (GSK), US.

Disclosures: Dr. Shorr has served as a speaker and consultant, in addition to receiving grant support from, Sanofi-Aventis and GSK; Dr. Moores is a speaker for Sanofi-Aventis in the past. Dr. Warkentin has served as a speaker and consultant for, and has received grant support from, both GSK and Sanofi-Aventis.

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Shorr, A.F., Jackson, W.L., Moores, L.K. et al. Minimizing costs for treating deep vein thrombosis: the role for fondaparinux. J Thromb Thrombolysis 23, 229–236 (2007). https://doi.org/10.1007/s11239-006-9042-3

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  • DOI: https://doi.org/10.1007/s11239-006-9042-3

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