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Fondaparinux Sodium Compared with Enoxaparin Sodium

A Cost-Effectiveness Analysis

American Journal of Cardiovascular Drugs volume 5, pages 121–130 (2005)Cite this article

Abstract

Introduction: Patients undergoing major orthopedic surgery face considerable risk of venous thromboembolism (VTE), which may be fatal unless they receive prophylactic treatment. Fondaparinux sodium is a new antithrombotic agent that is indicated for prophylaxis of VTE after major orthopedic surgery. This paper presents a cost-effectiveness analysis of fondaparinux sodium and enoxaparin sodium, the latter being the most commonly used agent for prophylaxis of VTE.

Methods: The analysis is based on an international simulation model, using Norwegian unit costs, and Norwegian data of 55 000 patients undergoing orthopedic surgery between 1999 and 2001. We estimated the expected incidence of VTE and VTE-related deaths, and expected costs of VTE-related care for each of the two prophylactic agents for different periods.

Results and conclusion: The results indicate that fondaparinux sodium is likely to be more effective than enoxaparin sodium in preventing the incidence of VTE. By day 90, fondaparinux sodium is expected to avoid 180 more VTE events, and between 8 and 33 more VTE-related deaths per 10 000 patients than enoxaparin sodium. Fondaparinux sodium is also a cost-saving option in short follow-up periods for hip fracture surgery. For extended follow-up periods (i. e. 5 years), fondaparinux sodium is also likely to represent the lower cost treatment option after total knee and hip replacement. The sensitivity analyses show that the main results are robust to changes in the most important parameters. Results are, however, sensitive to the price difference between the two drugs.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

  2. An alternative indicator of treatment-related bleeding (related to anticoagulation treatment of DVT or PE) is defined by only ICD-10 codes K62.5 and K92.2, which relate to gastrointestinal bleeding. This indicator is used for a subgroup of readmitted patients only.

  3. ICD-10 descriptors: I26 Pulmonary embolism; I60 Subarachnoid hemorrhage; I61 Intracerebral hemorrhage; I62 Other (nontraumatic) intracranial hemorrhage; I80 Phlebitis and thrombophlebitis; K62.5 Hemorrhage of anus and rectum; K92.2 Gastrointestinal hemorrhage, unspecified; R04 Hemorrhage from respiratory passages; R58 Hemorrhage, not elsewhere classified; T81.0 Hemorrhage and hematoma complicating a procedure, not elsewhere classified.

  4. DRG descriptors: 78 Pulmonary embolism; 128 Deep vein thrombophlebitis; 174 Gastrointestinal hemorrhage with complications; 175 Gastrointestinal hemorrhage without complications; 209 Major joint and limb reattachment procedures of lower extremity; 210 Hip and femur procedures except major joint, age >17, with complications; 211 Hip and femur procedures except major joint, age >17, without complications.

  5. Note in particular the high added net costs of THR at discharge. This is because the reduction in the number of VTE events by using fondaparinux sodium in the THR case is not so large: 33 more avoided cases of DVT and 19 of PE than enoxaparin sodium. Moreover, the treatment of these cases is not so expensive. These observations explain why the benefits of fondaparinux sodium are relatively modest, and therefore why the net cost per avoided case is so high.

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Acknowledgments

We would like to thank Frank R. Brosstad at the University of Oslo, Arild Aakvik at the University of Bergen, and Egil Kjerstad at the Institute for Research in Economics and Business Administration (SNF). We are grateful to three anonymous referees for useful comments.

The views expressed herein are those of the authors. This article is based on a report that was financed by Sanofi-Synthelabo, Norway. The authors retained the right to publish the results regardless of the outcome. The authors have no known conflicts of interest that are directly relevant to this manuscript.

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  1. Institute for Research in Economics and Business Administration (SNF), Breiviksveien 40, 5045, Bergen, Norway

    Afsane Bjorvatn & Frode Kristiansen

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  1. Afsane Bjorvatn
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Correspondence to Afsane Bjorvatn.

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Bjorvatn, A., Kristiansen, F. Fondaparinux Sodium Compared with Enoxaparin Sodium. Am J Cardiovasc Drugs 5, 121–130 (2005). https://doi.org/10.2165/00129784-200505020-00006

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Keywords

  • Pulmonary Embolism
  • Total Knee Replacement
  • Diagnosis Related Group
  • Enoxaparin Sodium
  • Fondaparinux Sodium