Cost Effectiveness of Enoxaparin in Acute ST-Segment Elevation Myocardial Infarction

Abstract

Based on a U.S. model of health care economics, the strategy of using enoxaparin instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI is cost effective according to commonly used benchmarks.

Economic Evaluation alongside Multinational Studies: A Systematic Review of Empirical Studies

“…A third study ignored data from all other countries and used data from only the country of interest [ 25 ]. Empirical Bayesian shrinkage, a method that involves borrowing strength from the overall trial to estimate country-specific cost-effectiveness [ 54 ], was used by only one study; however, the authors did not present the country-specific estimates [ 27 ]. The simplest approach was to state that the perspective of the analysis was related to a particular country and to apply unit costs from that country to the trial-wide data [ 34 , 36 , 37 , 46 , 52 ].…”

“…Multilevel modelling was used in three studies to account for the clustered nature of the data [ 27 , 49 , 50 ]. Other regression approaches such as controlling for country when estimating outcomes such as the QALY [ 43 ], adjusting for length of stay and costs within countries [ 51 ] and including interaction terms and country dummy variables [ 34 , 39 , 44 , 52 ] were also used.…”

“…It was noted that there are numerous differences between countries but no accepted guidance on how to account for them [ 35 , 46 , 53 ]. These differences include: differences in resource use, prices, health systems and practice patterns [ 27 – 29 , 31 , 39 , 46 , 47 , 52 , 54 , 58 – 60 ]. Estimating country-specific cost-effectiveness was another area in which there is no consensus amongst researchers [ 35 , 46 ].…”

“…The most common method of obtaining country-specific estimates was fully pooled one-country costing. Current recommendations by the ISPOR taskforce suggest that the more complex methods such as hierarchical modeling should be used for the analysis of multinational trial data [ 18 ] and a recent study also concluded that Bayesian hierarchical models are the most appropriate for estimating country-specific cost-effectiveness [ 22 ]; however, only one study in this review used this approach [ 27 ], suggesting that researchers are not adhering to existing guidelines, possibly because of the complexity associated with implementing this approach. Bayesian hierarchical models have been challenged because it assumes that differences between countries are random, whereas in reality, these differences are systematic [ 72 ].…”

Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review

“…Enoxaparin was shown to be an economically attractive option with an ICER of $5,700 per LY gained. (37) However, these data may not represent the contemporary practice where patients are managed primarily with primary PCI instead of fibrinolytic therapy.…”