Cost-Effectiveness Analysis of Anticoagulation Strategies in Non-ST-Elevation Acute Coronary Syndromes

Maxwell, C.; Holdford, David A.; Crouch, Michael A.; Patel, Dipen

doi:10.1345/aph.1l498

Cited by 12 publications

(4 citation statements)

References 15 publications

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“…In accordance with the results shown here, other economic evaluations around the world also demonstrated the best costeffectiveness ratio of fondaparinux compared to enoxaparin in hospitalized patients with ACSWSTE [21][22][23] . Univariate and multivariate sensitivity analyses confirmed the favorable economic result of the substitution of enoxaparin by fondaparinux.…”

Section: Discussionsupporting

confidence: 90%

Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST

Pepe¹,

Machado²,

Olimpio³

et al. 2012

Arq. Bras. Cardiol.

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Section: Discussionsupporting

confidence: 90%

Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST

Pepe¹,

Machado²,

Olimpio³

et al. 2012

Arq. Bras. Cardiol.

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“…Thus, the issue of designing and conducting trials that are streamlined and pragmatic with minimal data collection needs to be thought through carefully and is especially important for patients who may lose the chance for improved treatments if trials become too costly and unmanageable. There is also a need to "embed" reliable assessments of costs of treatment into clinical trials; to provide robust methods for health economic evaluation that does not rely on too many assumptions or complex modeling would also advance the field making the assessment of cost effectiveness more transparent and open [27]. Finally, most health care providers (governments, insurance companies, health care management organizations) are spending billions of dollars providing care for ACS patients, but only tiny proportions of this expenditure are being used to improve health care through research by finding new and more cost-effective treatments, or by improving the way health care is delivered.…”

Section: Discussionmentioning

confidence: 99%

What Goes Into a Major Acute Coronary Syndrome Trial and What Will Future Trials Look Like?

2010

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Acute coronary syndromes (ACS) are common and carry a high risk of death and serious complications. Over the past three decades, the international cardiology community has collaborated in numerous large, well-designed randomized trials evaluating promising new treatments leading to important improvements in care for patients with ACS. Industry has funded most of the ACS trials of new pharmacologic treatments, but there are many independently funded trials evaluating treatment strategies such as percutaneous coronary intervention. Improvements in ACS care have led to challenges in demonstrating the efficacy of new treatments and many current trials are comparing one active treatment against another, although new paradigms including anti-inflammatory treatments and stem cell infusions are being tested against placebo. Developing new drugs for ACS is a very expensive process with many trials not showing any benefit, and much of this expense is related to the cost of large multicenter phase 3 trials. Reducing the administrative burden and associated costs of ACS trials is an important immediate goal if the strong tradition of large collaborative trials is to continue, as well as the need for health care providers to engage more actively in the clinical research process and support large multinational independently funded trials. We discuss methodologic issues of ACS trials with recent examples and provide some perspectives for the future.

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“…The decision on which agents to use and when to administer them will depend on a number of factors, including whether the patient is managed with an invasive or conservative approach, which is dependent on risk (section 1). One recent modelled analysis [18] from a healthcare provider perspective that compared several contemporary anticoagulation strategies suggested that fondaparinux with a GP inhibitor was more cost effective than enoxaparin with a GP inhibitor, UFH with a GP inhibitor or bivalirudin, with regard to complication rates in patients undergo-ing a conservative treatment strategy; bivalirudin was the most cost effective in patients managed with an early invasive strategy. [2] Sculpher et al [14] (US) While treatment recommendations provide guidance, it is unclear which antiplatelet/anticoagulant regimen is the most cost effective in patients with NSTE-ACS.…”

Section: Pharmacoeconomic Positioning Of Fondaparinux In the Managemementioning

confidence: 99%

“…[2] In patients with unstable angina or acute MI without ST-segment elevation in the EU, subcutaneous fondaparinux is recommended in patients for whom urgent invasive management is not indicated. [18] Thus, in order to generate more meaningful conclusions, albeit more narrowly focused, we have limited our discussion of fondaparinux to cost-utility analyses based on a head-to-head trial (OASIS-5). Evaluating the costs of various treatment regimens requires relatively complex pharmacoeconomic modelling.…”

Section: Pharmacoeconomic Positioning Of Fondaparinux In the Managemementioning

confidence: 99%

Fondaparinux

McKeage

Lyseng‐Williamson

2010

PharmacoEconomics

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Fondaparinux (Arixtra) is an anticoagulant that selectively inhibits activated factor X, thereby interrupting the blood coagulation cascade. In OASIS-5, a large pivotal trial in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), subcutaneous fondaparinux 2.5 mg once daily was noninferior to subcutaneous enoxaparin 1 mg/kg twice daily (both agents were administered over a mean of about 5 days in combination with antiplatelet therapy) in reducing death or ischaemic events at 9 days, and the efficacy was maintained for up to 6 months (study end). However, fondaparinux was associated with a significantly lower rate of bleeding than enoxaparin in the first 9 days, and at 3 and 6 months. This lower rate of bleeding led to lower long-term mortality and morbidity with fondaparinux than with enoxaparin. In modelled cost-utility analyses conducted from a healthcare payer perspective in Spain, France and the US with a lifetime horizon, fondaparinux once daily was predicted to be cost effective relative to enoxaparin twice daily with regard to the incremental cost per QALY gained. In Spain and the US, fondaparinux dominated enoxaparin (i.e. was less costly and more effective) and, in the French analysis, the incremental cost per QALY gained with fondaparinux versus enoxaparin was well within recommended thresholds. Results of short-term (6-month) cost analyses in the US and France also favoured fondaparinux over enoxaparin. Sensitivity analyses demonstrated that base-case conclusions were robust over a range of parameter estimates and assumptions, including plausible variations in baseline risk of a cardiac event or baseline risk of bleeding. In conclusion, in patients with NSTE-ACS receiving antiplatelet therapy, fondaparinux was cost effective relative to enoxaparin in cost-utility analyses in Europe and the US. This cost advantage primarily reflects the lower rate of bleeding with fondaparinux than with enoxaparin and the lower rate of mortality and morbidity over the long term.

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Cost-Effectiveness Analysis of Anticoagulation Strategies in Non-ST-Elevation Acute Coronary Syndromes

Abstract: Bivalirudin is the least costly agent in moderate- to high-risk NSTE-ACS patients managed with an early invasive approach, if its use is consistent with the ACUITY trial. Fondaparinux is the preferred agent in patients undergoing a conservative treatment strategy.

Cited by 12 publications

References 15 publications

Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST

Custo-efetividade de fondaparinux em pacientes com Síndrome Coronariana Aguda sem supradesnivelamento do ST

What Goes Into a Major Acute Coronary Syndrome Trial and What Will Future Trials Look Like?

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