PharmacoEconomics

, Volume 18, Issue 1, pp 83–89 | Cite as

Economic Evaluation of Enoxaparin Sodium versus Heparin in Unstable Angina

A French Sub-Study of the ESSENCE Trial
  • Bruno Detournay
  • Xavier Huet
  • François Fagnani
  • Gilles Montalescot
Original Research Article

Abstract

Objectives: To perform an evaluation from the societal perspective of the cost of treatment with enoxaparin sodium versus unfractionated heparin (UFH) in patients with unstable angina and non-Q wave myocardial infarction in France.

Design: Four complementary cost-minimisation analyses based on the results of the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events (ESSENCE) international trial were conducted. We assessed differences in medical resource consumption and in duration of hospital stay in the whole study population (n = 3171) and for the French patients (n = 133).

Results: Resultswere consistent for the study group as a whole and for the French subgroup. Among patients treated with enoxaparin sodium, there was a statistically significant reduction in the use of angiography and percutaneous transluminal coronary angioplasty (whole group study: p = 0.024 and 0.006, respectively) and a trend towards shorter lengths of hospital stay. The differences in angiography and angioplasty rates led to estimated average net cost savings with enoxaparin sodium of French Francs (FF)1555 per treated patient (whole study population) and FF9993 (French subgroup) [1996 values]. The analyses based on the duration of hospital stay resulted in estimated net cost savings with enoxaparin sodium of between FF1014 per treated patient (whole study population) and FF2804 (French subgroup).

Conclusion: Our study confirmed earlier results which show that enoxaparin sodium is cost saving in the treatment of unstable angina.

Notes

Acknowledgements

The authors would like to thank Dr Durand-Zaleski (Hôpital Henri Mondor, Créteil, France) and Drs Placente and Huguet (Clinique de la Reine-Blanche, Orléans, France) for their helpful assistance in the development of this project. The funding for the study was partially from an unrestricted grant from Rhône-Poulenc Rorer Laboratories, Montrouge, France.

References

  1. 1.
    Theroux P, Quimet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med 1988; 319: 1105–11PubMedCrossRefGoogle Scholar
  2. 2.
    Wallentin L, RISC Group. Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990; 336: 827–30CrossRefGoogle Scholar
  3. 3.
    Braunwald E, Jones RH, Mark DB, et al. Diagnosing and managing unstable angina. Agency for Health Care Policy and Research. Circulation 1994; 90 (1): 613–22PubMedCrossRefGoogle Scholar
  4. 4.
    Cairns JA, Lewis HD, Meade TW, et al. Antithrombotic agents in coronary artery disease. Chest 1995; 108: 380–400CrossRefGoogle Scholar
  5. 5.
    Hirsch J. Low-molecular-weight heparin: a review of the results of recent studies on the treatment of venous thromboembolism and unstable angina. Circulation 1998; 98: 1575–82CrossRefGoogle Scholar
  6. 6.
    Cohen M, Demers C, Gurkinkel EP, the ESSENCE Study Group, et al. A comparison of low-molecular weight heparin with unfractioned heparin for unstable coronary artery disease. N Engl J Med 1997; 337: 447–52Google Scholar
  7. 7.
    Mark DB, Cowper PA, Berkowitz S, et al. Economic assessment of low molecular weight heparin (enoxaparin) versus unfractionned heparin in acute coronary syndrome patients: results from the ESSENCE randomized trial. Circulation 1998; 97: 1702–7PubMedCrossRefGoogle Scholar
  8. 8.
    Unger F. European survey on cardiac interventions, open heart surgery, PTCA, and cardiac catheterisation 1993. Report of the Institute for Cardiac Survey of the European Academy of Sciences and Arts. Ann Eur Acad Sci Arts 1994; 8: 1–154Google Scholar
  9. 9.
    Van den Brand M, the European Angioplasty Survey Group. Utilization of coronary angioplasty and cost of angioplasty disposables in 14 western European countries. Eur Heart J 1993; 14: 391–7CrossRefGoogle Scholar
  10. 10.
    Röthlisberger C, Meier B, the Working Group on Coronary Circulation of the European Society of Cardiology. Coronary interventions in Europe 1992. Eur Heart J 1995; 16: 922–9PubMedGoogle Scholar
  11. 11.
    Selby JV, Fireman BH, Lundstrom RJ, et al. Variation among hospitals in coronary angiography practices and outcomes after myocardial infarction in a large health maintenance organization. N Engl J Med 1996; 335 (25): 1888–96PubMedCrossRefGoogle Scholar
  12. 12.
    Fox KAA, Bosanquet N. Assessing the UK cost implications of the use of low molecular weight heparin in unstable coronary artery disease. Br J Cardiol 1998; 5: 92–105Google Scholar
  13. 13.
    Balen RM, Marra CA, Zed PJ, et al. Cost-effectiveness analysis of enoxaparin versus unfractionated heparin for acute conronary syndromes: a Canadian hospital perspective. Pharmacoeconomics 1999; 16 (5 Pt 2): 533–42PubMedCrossRefGoogle Scholar
  14. 14.
    Aden G. Fertigspritzen versus Ampullen: ein Anwendungsvergleich. Krankenhauspharmazie 1992; 5: 3–7Google Scholar
  15. 15.
    Fabregas X, Garcia B, Jimenez I. Prefilled syringes: a valuable addition to the pharmacy. Int Pharm J 1996; 10: 138–9Google Scholar
  16. 16.
    Cohen M, Bigonzi F, Le Louer V, the ESSENCE Group, et al. One year follow-up of the ESSENCE trial (enoxaparin versus heparin in unstable angina and non-Q-Wave myocardial infarction) [abstract]. JAmColl Card 1998; 31 Suppl. A: 820–2Google Scholar
  17. 17.
    Klein W, Buchwald A, Hillis SE, the FRIC investigators et al. Comparison of low molecular weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease: fragmin in unstable coronary artery disease study (FRIC). Circulation 1997; 96: 61–8PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Bruno Detournay
    • 1
  • Xavier Huet
    • 2
  • François Fagnani
    • 1
  • Gilles Montalescot
    • 3
  1. 1.Health Economics DepartmentCEMKABourg-la-ReineFrance
  2. 2.Rhône-Poulenc Rorer LaboratoriesMontrougeFrance
  3. 3.Cardiology DepartmentUniversity of Pitié-Salpétrière HospitalParisFrance

Personalised recommendations